GI Radiology > Esophagus > Foreign Bodies

Food Impactions & Foreign Bodies in the Esophagus

Introduction

  • Foreign body ingestion is a common and serious medical problem. Annually in the United States, 1500 people die of complications related to ingestion of foreign bodies (1). Although most swallowed objects pass spontaneously, 10% to 20% have to be removed by an interventional procedure, and approximately 1% require surgery (1-3).

  • Infants and children typically swallow such things as coins, button batteries, and small toys (3,6). Conversely, adults usually have problems with food impactions and bones. Children rarely have a problem with food unless they have a congenital or surgical stricture of the esophagus (6).
  • In adults, meat accounts for 70 - 80% of food impactions (6-9). Underlying pathology in the esophagus is a predisposing factor in most cases (6,8,10-13):

    1. The most commonly associated esophageal lesions are benign rings, strictures, or areas of spasm; cancer rarely causes food impaction (8,11,12,14,15-17).

    2. Other contributing factors may be the wearing of dentures, careless chewing, eating too rapidly, and alcohol intoxication (5,18,19,20).

  • In 1963, Norton and King (16) coined the term "steakhouse syndrome" to describe the clinical manifestations of esophageal obstruction occurring when a large piece of food (commonly steak) becomes impacted in the esophagus.

    1. The patient may present with a history of choking during eating, an inability to swallow saliva properly, drooling, and a persistent foreign body sensation in the throat or chest (3,5).

    2. The food lodges in the distal 1/3 of the esophagus in the majority of cases (65%-83%) (8,9,11,15).

    3. Although most adult patients with esophageal foreign bodies describe a clear history of foreign body ingestion or symptoms of impaction, clinical evidence is often inconclusive or absent in pediatric patients (3).

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