Cola therapy for oesophageal food bolus impactions a case series

Abstract

Introduction This retrospective case series describes the use of cola to immediately treat complete oesophageal food bolus obstructions in the emergency centre. Short of emergent endoscopy – which is invasive, expensive, not without adverse events, and often unavailable in low-resource settings – no other proven therapies exist to relieve oesophageal food impactions. Methods We performed a chart review of adults with complete oesophageal food bolus obstructions presenting to two Dutch emergency centres. Our primary outcome was cola’s success rate in resolving the obstruction. Our secondary outcome was adverse event occurrence. Results We identified 22 cola interventions in 19 patients, the majority of whom (77.3%) were male. The median age was 59 years (IQR 29–73). All presentations were due to meat impaction. Endoscopy revealed relevant upper gastrointestinal pathology in 54.5%. When initiated in the emergency centre, cola successfully resolved 59% of complete oesophageal obstructions. No adverse events were reported in patients successfully treated with cola. Discussion While keenly aware of our retrospective study’s limitations, we found a promising success rate for cola as an acute intervention for oesophageal food bolus impactions. We registered no adverse events attributable to cola. Also, given that cola is cheap, widely available and seemingly safe we believe it can be considered in patients with oesophageal obstructions due to food, either as pre-endoscopy treatment or in case endoscopy is not available at all. We think our findings provide an impetus for prospective research on this intervention.

Management of Adults with Acute Oesophageal Soft Food Bolus and Foreign Body Obstructions at Two New Zealand District Health Boards

“…They are commonly used, especially in resource poor countries, but the evidence supporting their use is limited to case reports and case series. 10 While a small 2019 South African series documented resolution of complete oesophageal obstruction in 13/22 (59%) cases with no adverse events, 11 other studies have reported complications including aspiration and oesophageal tear. 10 , 12 , 13 A 2005 review article reported success rate of 80% but a complication rate of 3% which exceeds that for therapeutic endoscopy.…”

Diagnostic et prise en charge de l’œsophagite à éosinophiles

“…On peut tenter de soulager l’obstruction œsophagienne aiguë par le bol alimentaire au moyen de modalités non effractives. La prise de boissons gazéifiées peut aider à déloger l’impaction alimentaire 48 . Si cette mesure se révèle inefficace, la personne devrait subir une endoscopie d’urgence.…”

“…Si cette mesure se révèle inefficace, la personne devrait subir une endoscopie d’urgence. Le glucagon, la butylscopolamine, les anticalciques, les nitrates et les benzodiazépines se sont révélés inefficaces lors de plusieurs études 48 , 49 . Une radiographie du thorax avant l’endoscopie a toujours été recommandée pour exclure une perforation de l’œsophage, mais les lignes directrices actuelles ne la recommandent pas en raison du taux élevé de résultats faussement négatifs 49 .…”

Acute onset dysphagia and neck pain after eating

“…Historically, patients with food bolus obstruction were given intramuscular hyoscine butylbromide to relax oesophageal smooth muscle; and disimpaction rates of 100%,4 80%,5 and 57%6 have been reported in small cohort and case studies when fizzy drinks were given. However, systematic reviews78 found no evidence to recommend that any medical intervention is more effective than “watching and waiting.”78…”