Esophageal food bolus obstruction Classification and external resources
Endoscopic image of patient with esophageal food bolus obstruction due to a grape in the setting of eosinophilic esophagitis
ICD-9	787.2
DiseasesDB	17942

An esophageal food bolus obstruction (or steakhouse syndrome^[1]) is a medical emergency caused by the obstruction of the esophagus by an ingested foreign body. Eosinophilic esophagitis is an allergic inflammatory condition of the Esophagus. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. The esophagus or oesophagus (see American and British English spelling differences) sometimes known as the gullet, is an organ in In Physiology, a foreign body (Latin corpus alienum) is any object originating outside the body It is usually associated with diseases that narrow the lumen of the esophagus, such as eosinophilic esophagitis, Schatzki rings, peptic strictures, webs, or cancers of the esophagus; rarely it can be seen in disorders of the movement of the esophagus, such as nutcracker esophagus. A lumen (Lat lūmen, an opening or light (pl lumina is the inside space or lining of a tubular structure such as an artery or intestine Eosinophilic esophagitis is an allergic inflammatory condition of the Esophagus. A Schatzki ring or Schatzki-Gary ring is a ring found in the lower part of the Esophagus that can cause difficulty swallowing A stenosis ( Plural: stenoses; from Ancient Greek στένωσις "narrowing" is an abnormal narrowing in a Blood vessel Esophageal cancer is malignancy of the Esophagus. There are various subtypes Nutcracker esophagus is a disorder of the movement of the Esophagus, and is one of many Motility disorders of the esophagus including Achalasia and While some esophageal food boluses can pass by themselves or with the assistance of medications, some require the use of endoscopy to push the obstructing food into the stomach, or remove it from the esophagus. Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an instrument called an endoscope. Endoscopic foreign body retrieval refers to the removal of ingested objects from the Esophagus, Stomach and Duodenum by endoscopic techniques

Clinical presentation

Many foods can lodge themselves in the esophagus, but the most common are meats such as steak, poultry, or pork^[2] leading to the colourful description of the phenomenon as steakhouse syndrome. The esophagus or oesophagus (see American and British English spelling differences) sometimes known as the gullet, is an organ in A steak (from Old Norse steik, "roast" is a slice of meat typically Beef. Poultry is the category of Domesticated Birds which some humans keep for the purpose of collecting their eggs, or kill for their Meat and/or Pork' is the Culinary name for Meat from the domestic Pig ( Sus scrofa) often specifically the fresh meat but can be used as an all-inclusive ^[1] People with food bolus obstruction typically display acute dysphagia (difficulty swallowing), often to the point that they cannot even swallow their saliva, leading to drooling. Dysphagia should not be confused with the similarly pronounced Dysphasia, a language disorder For the band see Saliva (band; for the village in Azerbaijan see Səliva. They may also suffer from chest pain, neck pain, regurgitation of food, or painful swallowing (odynophagia). Odynophagia is Painful Swallowing, in the mouth ( Oropharynx) or Esophagus. ^[3]

Patients with esophageal food boluses are also at risk of complications, such as perforation of the esophagus, and aspiration into the lungs. Boerhaave syndrome (also called Boerhaave's syndrome) or Esophageal perforation, is rupture of the esophageal wall Aspiration pneumonia is Bronchopneumonia that develops due to the entrance of foreign materials that enter the bronchial tree usually oral or gastric contents (including food As a result, urgent treatment of patients with high-risk features, or a lengthy duration of symptoms, is recommended. ^[4]

Predisposing conditions

Endoscopic image of a Schatzki ring which is a common cause of esophageal food bolus obstruction

Food bolus obstruction is most commonly caused by Schatzki rings, which are mucosal rings of unknown cause in the lower esophagus. A Schatzki ring or Schatzki-Gary ring is a ring found in the lower part of the Esophagus that can cause difficulty swallowing ^[1][5] Foodstuff jams into the esophagus due to the narrowing caused by the ring. An increasingly commonly recognized cause for esophageal food bolus obstruction is eosinophilic esophagitis, which is an inflammatory disorder of the mucosa of the esophagus, of unknown cause. Eosinophilic esophagitis is an allergic inflammatory condition of the Esophagus. The mucous membranes (or mucosae; singular mucosa) are linings of mostly endodermal origin covered in Epithelium, which are involved in ^[6][7] Many alterations caused by eosinophilic esophagitis can predispose to food boluses; these include the presence of multiple rings and narrowing of the lumen. ^[8] When considering esophageal dilation to treat a patient with food bolus obstruction, care must be made to look for features of eosinophilic esophagitis, as these patients are at a higher risk of dilation-associated complications. ^[9]

Other conditions that predispose to food bolus obstructions are esophageal webs and peptic strictures. Esophageal webs are thin membranes located in the middle or upper Esophagus. A stenosis ( Plural: stenoses; from Ancient Greek στένωσις "narrowing" is an abnormal narrowing in a Blood vessel ^[6] Food boluses are common in the course of illness in patients with esophageal cancer but are more difficult to treat as endoscopy to push the bolus is less safe. Esophageal cancer is malignancy of the Esophagus. There are various subtypes Patients with esophageal self-expandable metallic stents may present with food boluses lodged within the stent lumen. A self-expandable metallic stent (or SEMS) is a metallic tube or Stent, used in order to hold open a structure in the Gastrointestinal tract in order Rarely disorders of movement of the esophagus, such as nutcracker esophagus, can predispose to food bolus obstruction. Nutcracker esophagus is a disorder of the movement of the Esophagus, and is one of many Motility disorders of the esophagus including Achalasia and ^[10]

Treatment

The Roth net can be inserted through the endoscope to remove pieces of the obstructed food.

The standard treatment of food bolus obstruction is the use of endoscopy or fibre-optic cameras inserted by mouth into the esophagus. Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an instrument called an endoscope. ^[4] Endoscopes can be used to diagnose the cause of the food bolus obstruction, as well as to remove the obstruction. Traditional endoscopic techniques involved the use of an overtube, a plastic tube inserted into the esophagus prior to the removal of the food bolus, in order to reduce the risk of aspiration into the lungs at the time of endoscopy. lung is the essential Respiration organ in air-breathing Animals including most Tetrapods a few Fish and a few Snails The most primitive ^[6] However, the push technique, which involves insufflating air into the esophagus, and gently pushing the bolus toward the stomach instead, has emerged as a common and safe way of removing the obstruction. ^[6][11]

Other tools may be used to remove food boluses. The Roth net is a mesh net that can be inserted through the endoscope, and opened and closed from the outside; it can be used to retrieve pieces of obstructed food. Snares, which are normally used to remove polyps can be used to macerate the food causing the obstruction. A polyp is an abnormal growth of tissue ( Tumor) projecting from a Mucous membrane. Dormia baskets, which are metal baskets used to remove stones from the common bile duct in a procedure known as endoscopic retrograde cholangiopancreatography, can be opened and closed from the outside in a similar manner to macerate food and facilitate removal. Bile, which is synthesized in the liver is carried to the right and left hepatic ducts which converge along with the Cystic duct to form the Common hepatic duct. Endoscopic retrograde cholangiopancreatography ( ERCP) is a technique that combines the use of Endoscopy and Fluoroscopy to diagnose and treat certain problems Forceps used for biopsies can also be employed in a similar manner. Forceps are a handheld hinged instrument used for grasping and holding objects A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues ^[11]

Historical treatment of food bolus obstruction included administration of proteolytic enzymes (such as meat tenderizers), or even acidic substances, such as Coca-Cola with the purpose of degrading the meat that was blocked; however, this was often complicated by perforation of the esophagus. Proteolysis is the directed degradation ( digestion) of Proteins by cellular Enzymes called Proteases or by intramolecular digestion A meat tenderizer can refer to a tool or a chemical used for tenderizing Meat. Coca-Cola is a carbonated Soft drink sold in stores restaurants and Vending machines in more than 200 countries ^[12][13] Other modalities rarely used now include administration of anti-spasmodic medications, such as hyoscine butylbromide,^[14] removal of boluses using catheters,^[15] and the use of large-bore tubes inserted into the esophagus to forcefully lavage it. Butylscopolamine, also known as scopolamine butylbromide and hyoscine butylbromide is an Anticholinergic agent used as an Abdominal -specific In Medicine a catheter is a tube that can be inserted into a body cavity duct or vessel ^[16]

References