Oesophageal bolus impaction: role of glucagon, glyceryl trinitrate and carbonated drink
Glucagon, glyceryl trinitrate (GTN) and carbonated drinks are all considered measures, which can be implemented in the emergency department to relieve oesophageal food bolus impaction negating the need for urgent endoscopy. Glucagon and GTN are smooth muscle relaxants. Carbonated drinks increase intra-oesophageal pressure by releasing carbon dioxide and thereby forcing the food bolus into the stomach. The outcome of 45 episodes of oesophageal food bolus impaction presenting to the Bendigo Hospital emergency department between 2007 and 2009 was reviewed. Success was defined as the resolution of symptoms or no bolus seen on endoscopy. Symptoms resolved in three episodes and no bolus was seen on endoscopy in two episodes. Of these five episodes, all three modalities were implemented in one episode while glucagon and GTN was administered in two episodes. No significant difference was found when a comparison is made between the episodes where no intervention was implemented and where glucagon was administered alone or in conjunction with another measure (11.5 versus 10.5%, respectively). This is comparable to Tribbling et al. who found no significant difference between those given glucagon and diazepam and those given placebo.1 Al-Haddad et al. also concluded a lack of advantage of glucagon over placebo.2 There is minimal evidence regarding the efficacy of GTN in the management of oesophageal food bolus impaction. GTN was efficacious in two of 22 episodes, and on both occasions, it was administered in conjunction with glucagon. The efficacy of carbonated drinks is difficult to assess as there was no protocol in regard to the amount of carbonated drink administered. There is no strong evidence to suggest usage of these measures to relieve oesophageal food bolus impaction in this audit and endoscopy will inevitably be required to further ascertain a potential cause.
Rosemarie May Eyre, MB BS
Bendigo Health – Intern, Victoria, Australia
References
1. Tibbling L, Bjorkhoel A, Jansson E et al. Effect of spasmolytic drugs on esophageal foreign bodies. Dysphagia 1995; 10: 126–7.
2. Al-Haddad M, Ward EM, Scolapio JS et al. Glucagon for the relief of esophageal food impaction: does it really work? Dig. Dis. Sci. 2006; 51: 1930–3.
