Esophageal food impaction occurs when a bolus of food becomes lodged within the muscular tube connecting the throat to the stomach, known as the esophagus. This condition creates an uncomfortable, sudden blockage that prevents a person from swallowing anything further, including their own saliva. While often frightening, it is not the same as true choking, as the airway usually remains clear. The issue typically arises when a large, inadequately chewed piece of food cannot pass through a narrowed or dysfunctional section of the esophagus. Immediate, informed action is necessary, as a prolonged impaction can lead to serious complications.
Differentiating True Choking from Esophageal Impaction
It is important to distinguish between a true airway obstruction (choking) and a food impaction in the esophagus, as the required immediate response differs. True choking involves the blockage of the windpipe (trachea), which is a life-threatening emergency where the person cannot breathe, speak, or cough effectively. Symptoms include a panicked distress sign, blue or pale skin color, and an inability to make noise.
An esophageal impaction, conversely, occurs in the food pipe, allowing the person to continue breathing and speaking normally. Defining symptoms are pressure or pain in the chest or throat, and the inability to swallow saliva, which leads to excessive drooling (sialorrhea). Choking requires the Heimlich maneuver, but an esophageal impaction demands immediate medical consultation.
The Risks of Induced Vomiting for Removal
Attempting to induce vomiting to dislodge the stuck food is strongly discouraged because it introduces severe health risks without a reliable chance of success. The esophagus is a muscular tube designed to move food downward toward the stomach through rhythmic contractions (peristalsis). Forcing the food bolus upward works against this natural function.
The primary danger is aspiration, where stomach contents—including the lodged food and corrosive acid—are inhaled into the lungs. This can rapidly lead to aspiration pneumonia, a serious lung infection. Furthermore, the forceful retching and straining against the obstruction significantly increase pressure within the esophagus. This pressure can cause a tear in the esophageal wall, a life-threatening complication known as Boerhaave syndrome, which requires emergency surgery.
Immediate Action Steps When Food is Stuck
The most important step when experiencing a food impaction is to remain calm and immediately seek professional medical help. Call emergency services (e.g., 911) or proceed directly to an emergency department. Panic can exacerbate the situation and may lead to ill-advised maneuvers.
While waiting for medical assistance, avoid trying to force the food down by eating more food or drinking large amounts of liquid, which can worsen the blockage. Also, resist the temptation to induce vomiting or use aggressive physical action. If you cannot handle your secretions, do not attempt to drink water, as this increases the risk of aspiration.
Professional Medical Procedures for Relief and Underlying Causes
Once a patient reaches the hospital, medical professionals prioritize the safe removal of the food bolus. An initial intervention may involve the intravenous administration of glucagon, a hormone that relaxes the smooth muscle of the lower esophageal sphincter. The goal is to relax this muscular ring, allowing the impacted food to pass naturally into the stomach. However, glucagon’s efficacy is variable, and it can sometimes cause nausea and vomiting.
If the impaction does not resolve spontaneously or with medication, the standard treatment is an emergency endoscopy, typically performed by a gastroenterologist within 24 hours. During this procedure, a flexible tube with a camera is passed down the throat to visualize the obstruction. The physician will then either gently push the food bolus into the stomach or use specialized tools like nets or snares to safely extract it through the mouth.
Underlying Causes of Impaction
Most episodes of esophageal food impaction suggest an underlying condition that requires diagnosis and management. The most common underlying cause is Eosinophilic Esophagitis (EoE), an inflammatory, allergic condition that causes narrowing and stiffening of the esophagus. Other common causes include Schatzki rings, which are narrow bands of tissue, or peptic strictures, which result from long-term damage caused by acid reflux. Identifying and treating these conditions is necessary to prevent recurrent episodes of food impaction.