![]() G&H What is the best treatment method for an unresolved food bolus impaction? This may also be scrutinized in the patient history. Quality plain and lateral film of the chest and neck should be taken, depending on the location of the suspected impaction, and examined carefully for evidence of bones. Again, radiographic imaging can be helpful in this regard. Thus, one of the appropriate concerns in the evaluation and management of food bolus impaction, particularly in a meat impaction, is whether or not there may be unrecognized bones in the food bolus. However, anything put into the mouth should ultimately be considered a foreign object, including the contents of a food bolus. Therefore, radiographic imaging should be incorporated into investigation and management in order to make that distinction. Ingested foreign objects are also, for the most part, radiopaque. Foreign object ingestion may be intentional or accidental. This should be available through an honest and accurate history of presenting illness. GG It is important to discriminate a food bolus impaction from a true foreign object ingestion. G&H Should any steps be taken to differentiate an impacted food bolus from a foreign object? The most commonly impacted foods are beef, chicken, pork, and al dente-cooked vegetables. Contributing conditions could be poor dentation, illfitting dentures, the use of alcohol, or a predisposition to eat too quickly. Some of the classic presentations of food bolus impaction are “the steakhouse syndrome” or the “backyard barbeque syndrome.” Not surprisingly, impactions occur more often when patients are eating meat and generally when they do not chew their food sufficiently. In these patients, the impaction generally passes after a period of relaxation where the muscles of the esophagus are no longer constricted and allow the bolus to pass. In terms of motility disorders, diffused motor abnormalities of the esophagus or esophageal spasm can cause transient food bolus impactions. In terms of mechanical etiologies, strictures or narrowing of the esophagus are most commonly caused by Schatzki ring, peptic stricture, or, increasingly, the presence of eosinophilic esophagitis. GG Food bolus impactions are commonly accompanied by some underlying component of pathology, which can be either mechanical or functional. G&H What are the primary causes of food bolus impaction? ![]() They can talk and they can cough, whereas a person who is truly choking is unable to do any of these things. Patients with food bolus impaction do not have any interruption of breathing. It is important to differentiate impaction from choking. ![]() Patients are also unable to eat or drink anything further when experiencing an impaction. However, food bolus impaction is additionally associated with sialorrhea or excessive salivation, which accompanies esophageal obstruction. Patients primarily experience a sensation of squeezing in the chest, which can be frightening as it is difficult to discriminate from heart attack pain. When symptoms of obstruction persist and/or are accompanied by substantial chest discomfort, patients will seek medical attention. Most food bolus impactions resolve without intervention, either by moving forward to the stomach or by the patient regurgitating the ingested contents. ![]() GG Food bolus impactions are acute events that, for the most part, are immediately recognized by the patient. G&H Could you describe the typical presentation of a patient experiencing a food bolus impaction? ![]()
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