Food Impaction

Meat impaction may be treated expectantly, providing the patient can manage his or her own secretions. Time and sedation often will allow the meat to pass into the stomach, but the bolus should not be allowed to remain impacted longer than 12 h. Endoscopy is the preferred method for removal. Alternatives have been suggested if endoscopy is not available.

The use of proteolytic enzymes, such as an aqueous solution of papain (e.g., Adolph's meat tenderizer), to dissolve a meat bolus is not recommended, however, because of the number of reported complications and because of increasing availability of and expertise in endoscopy. Several reports in the literature have described esophageal perforation secondary to the enzymatic action of the solution. Mucosal ischemia resulting from distention of the esophageal wall renders the esophagus more susceptible to enzymatic degradation. Hemorrhagic pulmonary edema also has been reported following aspiration of Adolph's meat tenderizer.

Intravenous administration of glucagon to relax esophageal smooth muscle also has been suggested as a method of treating food impaction. A test dose should be given to ensure that hypersensitivity does not exist; then the recommended dose is 1 mg. If the food bolus is not passed in 20 min, an additional 2 mg is given intravenously. An esophagogram must be performed following treatment to ensure passage. This strategy was questioned by Tibbling and associates, 9 who found no statistical difference in disimpaction rates between patients given spasmolytic drugs and those given placebo. For patients with esophageal obstruction caused by food, more efficient approaches to treatment are endoscopy and esophagoscopy.

Bellâ„¢ reports the successful use of nifedipine, which reduces lower esophageal sphincter pressure and the amplitude of the sphincter contractions without changing the amplitude of contractions in the body of the esophagus. By this mechanism, a bolus of food lodged in the vicinity of the gastroesophageal junction may pass. The recommended dose is 10 mg administered sublingually. Sublingual nitroglycerin has also been used successfully, but could cause hypotension.

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