The use of honey in button battery ingestions: a systematic review

Abstract

BackgroundButton battery (BB) ingestions may cause severe and possibly fatal complications, especially if the battery is located in the esophagus. The application of oral honey has recently been proposed by the National Capital Poison Center in the USA and in an ESPGHAN position paper in Europe, but clinical trials and experimental studies are limited. The goal of this systematic review was to analyze the evidence for this approach.Materials and methodsA systematic review of clinical trials and experimental studies on the oral application of honey after BB ingestion in children was performed. Inclusion criteria according to the PICO format were patient age 0–18 years, ingestion of BB, oral administration of honey or other substances, all in vivo and in vitro studies, as well as reported complication rate, esophageal injury, and mortality. A manual search in the databases MEDLINE, Web of Science and Cochrane was performed to identify relevant search terms to form the following queries and to construct the extensive search. Furthermore, the search was extended by using snowballing on the reports reference lists. The review is registered at Research Registry. The identifying number is reviewregistry1581.ResultsWe found four publications that investigated the effects of honey after button battery ingestion. Three of these presented experimental in vitro and in vivo results and one reported a clinical retrospective study of 8 patients.ConclusionFollow up studies are required to further elucidate the effectiveness of the treatment with honey. The time intervals in which the use of honey is effective is not clear. Furthermore, a physiological model is needed for in vitro testing, preferably mimicking peristalsis and dynamic flow of the applied substances. However, since it is easy to apply and of minimal risk in patients over one year of age, honey should be considered a possible treatment option during the interval between presentation and endoscopic removal of the retained BB.Systematic Review Registrationhttps://www.researchregistry.com/browse-the-registry#registryofsystematicreviewsmeta-analyses/registryofsystematicreviewsmeta-analysesdetails/643e9df96750410027ee11b0/, identifier: reviewregistry1581.

Foreign Body Ingestion in Children: An Experience of 99 Cases in a Tertiary Care Center in Delhi

“…have discussed the use of honey in managing button battery ingestion. [ 16 ] The same was followed here in two cases, and we report satisfactory results. Emetics are not preferred to be used in cases of foreign body ingestion as they increase the risk of aspiration or lodging of the object in a new location causing further complications.…”

“…[ 2 ] Endoscopic removal of seven button batteries was done within 24 h (four being retrieved from the esophagus and three from the stomach), while two cases of button batteries could be managed by observation and after giving honey as they had passed the DJ flexure. [ 16 ] The NASPGHAN Endoscopy Committee recommends observation of asymptomatic children above the age of 5 years who present with a short duration of ingestion (<2 h) of a small-sized battery (<20 mm). [ 12 ] In such cases, a close radiographic follow-up along with honey ingestion can help in documenting the progression of the foreign body out of the gastrointestinal tract.…”

“…[ 12 ] In such cases, a close radiographic follow-up along with honey ingestion can help in documenting the progression of the foreign body out of the gastrointestinal tract. [ 16 ] However, if the battery is not excreted in a week, endoscopic removal should be done. The two cases managed conservatively came 24 h after ingestion and had only ingested small 10-mm batteries.…”

Foreign Bodies in Pediatric Otorhinolaryngology: A Review

“…Recent literature and guidelines support using honey after button battery ingestion in children over one year before endoscopic removal. This is due to its ease of application, minimal risk and proven ability to reduce mucosal injury [ 138 , 139 , 140 ]. It is recommended to use it with sucralfate only within 12 h of ingestion while waiting for endoscopic removal [ 139 ].…”

“…It is recommended to use it with sucralfate only within 12 h of ingestion while waiting for endoscopic removal [ 139 ]. However, further studies are needed to clarify the effectiveness of honey treatment and the optimal treatment intervals completely [ 138 ]. In addition to using honey, it is advised to rinse with acetic acid after removing the button battery.…”