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Effervescent agents for oesophageal food bolus impaction
  1. Jason Lee, Specialist Registrar,
  2. Ross Anderson, Senior House Officer
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jonesman.ac.uk

    Abstract

    A short cut review was carried out to establish whether fizzy drinks alone are effective at resolving food bolus impaction. Altogether 46 papers were found using the reported search, of which six presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated

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    Report by Jason Lee, Specialist RegistrarChecked by Ross Anderson, Senior House Officer

    Clinical scenario

    It is Christmas day when a 70 year old woman is brought to the emergency department by her family with a history of oesophageal obstruction after eating her turkey dinner. You wonder if a fizzy drink might resolve the obstruction.

    Three part question

    In [a patient with food bolus impaction] are [effervescent agents effective] at [inducing resolution and minimising complications]?

    Search strategy

    Medline 1966-10/04 and Embase 1966-10/04 using the Ovid interface. Medline: [effervescent.mp OR fizzy.mp OR exp carbonated beverages OR coke.mp OR cola.mp OR coca-cola.mp OR sodium bicarbonate.mp OR exp sodium bicarbonate OR exp citric acid OR citrate.mp OR citric acid.mp OR tartaric acid.mp OR carbex.mp OR gas-forming.mp] AND [exp Esophageal Stenosis OR {(oesophag$.mp OR esophag$.mp) AND (food.mp OR bolus.mp OR exp foreign bodies OR foreign bod$.mp OR meat.mp OR impact$.mp OR obstruct$.mp OR dysphagia.mp OR steak$.mp)}] LIMIT to human AND English language. Embase: [(effervescent.mp OR fizzy.mp OR exp carbonated beverages OR coke.mp OR cola.mp OR coca-cola.mp OR sodium bicarbonate.mp OR citrate.mp OR exp citric acid OR citric acid.mp OR exp tartric acid OR tartaric acid.mp OR exp carbex OR carbex.mp OR gas-forming.mp) AND [exp esophagus obstruction OR {(oesophag$.mp OR esophag$.mp) AND (food.mp OR bolus.mp OR exp Foreign body OR foreign bod$.mp OR meat.mp OR impact$.mp OR obstruct$.mp OR dysphagia.mp OR steak$.mp)}] LIMIT to human AND English language.

    Search outcome

    Altogether 35 papers were found in Medline and 46 papers in Embase. After exclusion of papers using a combination of glucagon or buscopan with effervescent agents, six papers remained that were relevant to the question posed (table 3).

    Table 3

    Comment(s)

    Effervescent agents have successfully resolved oesophageal food impaction in a number of cases. However, these studies represent only low level of evidence (case reports, case series, or case-control studies) and in most studies the patients had undergone prior barium swallow to conclude the diagnosis. It is feasible that these cases resolved through the “weight of column effect” of the barium. A wealth of correspondence exists in journals from clinicians stating that they have used effervescent agents “many times” safely and successfully. They do not, however, provide data. Overall, the published success rate of effervescent agents is 80% (52 of 65 cases). The complication rate, 3% (2 of 65 cases), is low but exceeds the figures quoted in the literature for endoscopic removal. More research is needed in this area.

    CLINICAL BOTTOM LINE

    Effervescent agents seem to be effective at resolving oesophageal food obstruction but their use is not without risk of complications. Consultation with ENT before their use is recommended.

    Report by Jason Lee, Specialist RegistrarChecked by Ross Anderson, Senior House Officer

    References

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