%0 Journal Article
%T Pharmacological Management of Esophageal Food Bolus Impaction
%A Yasir Mohammed Khayyat
%J Emergency Medicine International
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/924015
%X Background. Soft esophageal bolus impaction is an emergency that requires skilled endoscopic removal if persistent obstructive symptoms do not resolve spontaneously after careful observation. Expedited care of these patients is crucial to avoid respiratory and mechanical complications. Other possible options for management include medical agents used to manage it prior to performing endoscopy if access to endoscopy was not available or declined by the patient. Aim. To review the available pharmacological and other nonmedicinal options and their mechanism of relief for soft esophageal impaction. Method. Pubmed, Medline and Ovid were used for search of MESH terms pertinent including ¡°foreign body, esophageal, esophageal bolus and medical¡± for pharmacological and non medicinial agents used for management of esophageal soft bolus impaction as well as manual review of the cross-references. Results. Several agents were identified including Buscopan, Glucagon, nitrates, calcium channel blockers, and papaveretum. Non medicinal agents are water, effervescent agents, and papain. No evidence was found to suggest preference or effectiveness of use of a certain pharmacological agent compared to others. Buscopan, Glucagon, benzodiazepines, and nitrates were studied extensively and may be used in selected patients with caution. Use of papain is obsolete in management of soft bolus impaction. 1. Introduction Foreign body esophageal impaction is a common emergency that ranks third after upper and lower gastrointestinal bleeding. It has annual incidence of 13£¿:£¿100£¿000 among the general population with a male to female predominance 1.7£¿:£¿1. The rate of occurrence increases with age, particularly in patients over seventy years [1]. Esophageal impaction can be distinguished into two types: (a) true foreign body impaction caused by objects such as blunt- or sharp-pointed objects and in relation to other miscellaneous objects that could occlude the lumen; (b) food impaction due to nonsolid material in the esophagus [2]. It is managed endoscopically either by pushing or extracting the impacted material in the esophagus using flexible or rigid endoscopy [3¨C5]. However, a survey conducted among UK practitioners showed that the majority did not usually proceed immediately to rigid esophagoscopy to remove the food bolus impaction mechanically; rather, they prefer to use antispasmodic drugs (83%), the most common being hyoscine butylbromide (Buscopan) and diazepam, to try to induce spontaneous passage of the obstruction [6]. Endoscopic skills to perform upper endoscopy are varied,
%U http://www.hindawi.com/journals/emi/2013/924015/