Esophageal food bolus obstruction

Esophageal food bolus obstruction (EFBO) is a medical condition characterized by the impaction of a food bolus in the esophagus. This condition can lead to difficulty swallowing (dysphagia), pain, and potentially serious complications if not promptly addressed. EFBO is considered a gastrointestinal emergency and requires immediate medical attention.

Causes

EFBO is most commonly caused by an underlying esophageal disorder that narrows the esophagus, making it difficult for food to pass. These conditions include:

• Esophageal stricture: Narrowing of the esophagus due to scar tissue, often resulting from chronic gastroesophageal reflux disease (GERD) or radiation therapy.
• Eosinophilic esophagitis: An allergic condition causing inflammation and narrowing of the esophagus.
• Esophageal cancer: A malignant tumor that can obstruct the passage of food.
• Achalasia: A disorder affecting the ability of the esophagus to move food toward the stomach.

Symptoms

The primary symptom of EFBO is the sudden onset of dysphagia, especially with solid foods. Other symptoms may include:

• Pain or discomfort in the chest
• Regurgitation of food
• Salivation
• Coughing or choking (if the food enters the airway)

Diagnosis

Diagnosis of EFBO typically involves a combination of medical history, physical examination, and diagnostic tests, including:

• X-ray with a barium swallow: A special type of X-ray that visualizes the esophagus after the patient swallows a barium solution.
• Endoscopy: A procedure using a flexible tube with a camera to visually inspect the esophagus and remove the food bolus.

Treatment

Treatment for EFBO aims to remove the obstruction and address the underlying cause. Methods include:

• Endoscopic removal: The most common and effective treatment, where an endoscope is used to either push the food bolus into the stomach or extract it.
• Pharmacological treatment: The use of glucagon or nitroglycerin to relax the esophageal muscles and facilitate the passage of the food bolus.
• Esophageal dilation: Widening of the esophagus using a balloon or dilators to prevent future obstructions.

Prevention

Prevention of EFBO involves managing underlying esophageal conditions, chewing food thoroughly, and avoiding large bites of hard-to-swallow foods.

Complications

If not treated promptly, EFBO can lead to complications such as:

• Aspiration pneumonia: Inhalation of food particles into the lungs.
• Esophageal perforation: A tear in the esophagus, leading to a serious infection.
• Airway obstruction: A life-threatening condition if the food bolus blocks the airway.

See Also

• Gastroesophageal reflux disease
• Barrett's esophagus
• Esophagectomy