Oesophageal food bolus impaction

Impaction of food (usually meat) in the oesophagus is uncomfortable and occasionally serious. Although impaction can occur in patients without a known abnormality of the oesophagus, an underlying cause (eg gastro-oesophageal reflux disease, benign oesophageal stricture, Schatzki ring, eosinophilic oesophagitis, distal oesophageal spasm, oesophageal cancer) can usually be identified on subsequent investigation.

By the time of presentation, patients with oesophageal food bolus impaction have generally tried drinking water to clear the obstruction. Drinking 25 to 50 mL of a carbonated drink (taking care to avoid aspiration) may be helpful as initial therapy, possibly by increasing intra-oesophageal pressure or causing changes in oesophageal motility. If this is ineffective, addition of a smooth muscle relaxant may be helpful; use:

1glyceryl trinitrate spray 400 to 800 micrograms sublingually, as a single dose glyceryl trinitrate glyceryl trinitrate glyceryl trinitrate

OR

1glyceryl trinitrate tablet 600 to 1200 micrograms sublingually, as a single dose.glyceryl trinitrateglyceryl trinitrate glyceryl trinitrate

If glyceryl trinitrate is inappropriate or ineffective for oesophageal food bolus impaction, useASGE Standards of Practice Committee, 2011Hackett, 2021:

glucagon 1 mg subcutaneously or intravenously, as a single dose. glucagon glucagon glucagon

If the above therapy is ineffective, upper gastrointestinal endoscopy may be required. This should be performed urgently if the patient is unable to swallow their saliva.

Note: Urgent upper gastrointestinal endoscopy is required if a patient with oesophageal food bolus impaction is unable to swallow their saliva.

Longer-term management depends on the underlying cause, which should be sought (with endoscopy and biopsy of the oesophageal mucosa) and treated.