When food becomes lodged in the tube connecting your throat to your stomach, it is known as a food bolus impaction (FBO). This situation is extremely uncomfortable, often causing chest pain and a sensation of fullness. An obstruction in the esophagus typically leaves the windpipe, or trachea, clear. This means a person experiencing an FBO can usually still breathe, talk, and cough effectively, distinguishing it from a life-threatening airway blockage.
Immediate Steps for a Non-Choking Incident
If you are experiencing the uncomfortable sensation of food stuck in your esophagus but are breathing normally, there are simple, non-invasive steps you can attempt. The primary goal is to encourage the smooth muscles of the esophageal wall to relax or allow the food to pass spontaneously. Most food impactions resolve on their own, often by moving into the stomach or being regurgitated.
One method often suggested involves drinking a carbonated beverage, such as soda. The theory is that the carbon dioxide gas released in the esophagus can help distend the tube, creating pressure that may dislodge the food bolus. The effervescence may also help break down the food slightly or cause the esophagus to relax, facilitating passage into the stomach. Slowly sipping a small amount of liquid, such as water or a fizzy drink, may be enough to start the movement.
You should avoid trying to force the food down by swallowing more food or large volumes of water, as this can worsen the impaction or increase the risk of aspiration. Do not attempt to use any tool to reach down your throat, or try to induce vomiting, especially if the pain is severe. If the food does not pass after a few simple attempts with sips of liquid, or if symptoms persist for more than a few hours, seek professional medical attention.
Recognizing a Life-Threatening Airway Blockage
It is necessary to differentiate between a food impaction in the esophagus and a blockage in the trachea, which is a life-threatening emergency. A person with an esophageal food bolus impaction can typically speak, cough, and take a breath, even if swallowing saliva is painful or difficult. The sensation of a lump may be present, but the airway remains open.
In contrast, a person with a true airway obstruction, or choking, will show clear signs of distress because the windpipe is blocked. They will be unable to speak, cough weakly or not at all, and may clutch their throat in the universal sign for choking. Their skin, lips, or nails may also turn blue due to lack of oxygen.
If you observe these signs of choking, immediately call for emergency medical services and begin abdominal thrusts, commonly known as the Heimlich maneuver. This action uses residual air in the lungs to forcefully dislodge the obstruction from the trachea. Timely recognition and intervention in a true choking scenario are paramount to survival.
Professional Medical Procedures for Removal
If the food impaction does not resolve on its own, medical intervention is necessary, typically in an emergency department setting. Physicians may first attempt a pharmacological approach using the hormone Glucagon, administered intravenously. Glucagon relaxes the smooth muscles, particularly the lower esophageal sphincter, which may allow the impacted food to pass into the stomach. However, Glucagon’s overall effectiveness is debated, and it should not delay definitive treatment.
The definitive procedure for removing an impacted food bolus is an upper endoscopy, also known as esophagogastroduodenoscopy (EGD). This procedure involves passing a thin, flexible tube equipped with a camera, called an endoscope, through the mouth and down into the esophagus. The patient is usually sedated for comfort and safety.
Once the endoscope reaches the obstruction, the physician employs one of two main techniques. The “push technique” involves gently advancing the food bolus forward into the stomach; this is the preferred and often safer method if the food is soft and the esophagus appears healthy. If the impaction is dense, or if there is concern about damage to the esophageal lining, the physician uses the “extraction technique.” This involves employing specialized tools like nets, snares, or grasping forceps passed through the endoscope to safely break up and retrieve the food through the mouth.
Lifestyle and Behavioral Changes for Prevention
Recurrent food impactions strongly suggest an underlying issue in the esophagus requiring diagnosis and management. Conditions that narrow the esophageal opening, such as Schatzki’s rings, or inflammatory diseases like eosinophilic esophagitis (EoE), are frequent contributing factors. Chronic acid reflux can also lead to the formation of peptic strictures, which are bands of scar tissue that restrict the passageway.
Consulting a physician for a thorough evaluation is highly recommended after an impaction, as identifying and treating these underlying conditions prevents future episodes. For example, in the case of EoE, a doctor may prescribe medications to control inflammation in the esophageal lining. For mechanical narrowings, a procedure called dilation may be performed to gently stretch the restricted area.
Behavioral modifications are also an important part of prevention, regardless of any underlying medical diagnosis. You should focus on chewing food thoroughly until it is a paste-like consistency before swallowing. Eating slowly and deliberately, cutting food into small pieces, and avoiding large bites are important habits to adopt. Drinking water throughout a meal can also help ensure the food bolus moves smoothly.