It is 11 p.m., you have just gone to bed and the phone rings. It is the hospital nursing supervisor calling to say the gastroenterologist has asked that the GI nursing "on-call" team be called in for an emergency procedure. There is an emergency room (ER) patient with a food impaction. When you arrive in the ER, you meet a man who has eaten ham for supper. The meat has become lodged in his esophagus and he has continued to eat to attempt to push the impaction down into his stomach. When you further question the man about whether this is the first time he has been having dysphagia, he states, "Oh no, this has been happening for months. This is the first time I haven't been able to get it to go down." Food impactions are an emergent event that probably could be avoided with patient education.
Esophageal food impactions are usually the result of either a Schatzki's ring or an esophageal stricture. Schatzki's rings are thin concentric rings made up of mucosa and muscle that form at the esophagogastric junction. A common symptom is dysphagia, especially after eating quickly. Diagnosis is usually made with a barium swallow or endoscopic examination. Symptoms are usually relieved by esophageal dilatation. Esophageal stricture is an abnormal formation of white fibrous tissue that is usually found at the lower end of the esophagus.1 Strictures can be the result of caustic injury, candida infection or prolonged and severe gastroesophageal reflux and worsening dysphagia. Diagnosis is made with endoscopic examination including biopsies and cytology brushings to exclude malignancy. Treatment is esophageal dilatation and medication to treat the candida infection or esophageal reflux.
Most food impactions can be prevented with patient education. Patients usually receive education after a food impaction has taken place. The time for education is before a food impaction has occurred. Anti-ulcer drug companies have started to advertise to make the public aware of symptoms that should lead them to seek medical advice about burning and acid reflux. These advertisements are having a definite positive impact educating patients about acid reflux disease. Dysphagia needs to be added to their advertisements to help people realize that this condition is not normal. Patients should be seeking medical help as soon as symptoms occur.
Patient education for those faced with an emergent food impaction include the following guidelines:
- Do not continue to eat. Patients have been known to continue eating in an attempt to force the food through the esophagus. Most of the time this does not solve the problem and can in fact make matters worse.
- Wait 15-20 minutes to see if food passes into the stomach. If it does not, call your doctor and go to the emergency room immediately. The longer food stays lodged in your esophagus, the more damage that can occur.
After a food impaction removal, most patients will be placed on an anti-ulcer/anti-reflux agent to heal their esophagus and to prevent further reflux damage. Patients should be instructed not to stop taking this medication without the advice of their physician.
The best advice nurses can give patients is if they are having difficulty getting food to go down their esophagus, they should see a physician. The physician will evaluate their esophagus, begin treatment if necessary and hopefully prevent that middle-of-the-night emergency room visit due to a food impaction.