We have all experienced what an incessantly hectic work-day is like – one in which we don’t even have the time to get a bite to eat; and consequently, when the time finally comes…when we get a hold of that meal, we tend to ingest the food – or rather, inhale it – as quickly as humanly possible in hopes of promptly satiating our stomachs. Yet, when food is devoured quickly and in large quantities it can become obstructed, a condition known as a food bolus impaction. In some cases, the impaction will spontaneously resolve, but when it doesn’t, it becomes a dangerous situation in which patients will require an emergency procedure. Frequently, patients who suffer from a food bolus impaction possess structural abnormalities that predisposes them to an esophageal blockage, and in a preponderance of cases, patients are unaware of these anatomical deformities. Therefore, it is important for the public to learn about all the risk factors associated with a food bolus impaction, as this may someday save them or someone they know from a life-threatening choking episode.
When food is ingested, it has to traverse from the oral cavity into the 10-inch esophageal tube. The esophagus contains three naturally occurring areas of narrowing and, not surprisingly, these are the most common sites of food bolus impactions. In addition to this, patients may also have internal anatomical aberrations which could lead to a blockage, and these include: diverticula (protruding pouches); rings (extraneous tissue that extends from the inner wall); strictures (areas of narrowing due to scar tissue formation); and tumors. Patients with a food bolus impaction will typically present with difficulty swallowing and neck pain. However, in severe cases, they will manifest the following symptoms: choking, drooling, regurgitation of food, wheezing, and respiratory distress. The diagnosis is generally made by direct visualization of the food item via an endoscope, which is a special camera that can be inserted into the esophagus. The treatment involves the use of tools attached to the endoscope which allow the physician to break up the food item, push it forward, or retrieve it. If the gastroenterology specialist detects any of the aforementioned structural abnormalities, they can also treat those via the endoscope.
Food bolus impactions can cause significant complications (e.g. pulmonary aspiration of the food particles), and as a result, these obstructions need to be treated within 12 hours of onset. One may have heard of patients receiving a substance known as a meat tenderizer (a chemical used to degrade meat products) to get rid of an esophageal impaction, but this is no longer recommended as it can cause a perforation of the esophagus. Oftentimes, patients with the aforementioned anatomical abnormalities will have noticed that their food sluggishly treads down the esophagus, a classic warning sign of an inhibiting lesion. Nevertheless, whether you have a predisposing medical condition or not, you can still get a food bolus impaction, so taking proactive measures is an easy alternative. Thus, take your time while eating and make sure that you carefully chew your food, given that this will save you from an untimely Heimlich maneuver and the business end of an operating room endoscope.