The holidays can be a busy time of year for emergency room visits for “food bolus impaction” — food lodged in one’s esophagus from overeating or wolfing down food.
Search “food,” “stuck,” “throat,” and a popular home therapy includes the “Coke Hack”: If it isn’t blocking the airways and causing choking (the person is unable to breathe or talk, a medical emergency that requires an immediate call to 911 and rescue techniques like the Heimlich maneuver) try sipping Coca-Cola. The drink’s “effervescent agents” are said to help dissolve and loosen stuck food.
A new study, however, found Coke has no meaningful effect on a blocked esophagus. The randomized controlled trial showed that cola did not help free stuck food in emergency patients awaiting an emergency endoscopy.
“We would like to caution the public around the holidays that as yet, no quick and pleasant treatment has been proven to resolve food bolus impactions after copious meals,” researchers from the Amsterdam University Medical Centers write in the BMJ’s Christmas edition, a traditional blend of quirky commentary and peer-reviewed research.
Food boluses are common, uncomfortable and often painful. “If a piece of food is larger than the diameter of the esophagus, it will get stuck,” said Dr. Arjan Bredenoord, professor of gastroenterology at Amsterdam UMC and the study’s lead author.
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If the esophagus is completely obstructed, the person can’t swallow his or her saliva. “They either spit it out or they can aspirate the saliva,” so that it enters the windpipe, causing shortness of breath, coughing or pneumonia, Bredenoord said.
The problem can be caused by a narrowing of the esophagus due to a scar from a previous inflammation, reflux disease, a tumour or other underlying abnormality. In severe cases a food bolus can lead to perforation of the esophagus, even death.
According to the authors, holidays tend to see an uptick in people with food bolus impaction caused by superabundant meals and “tachyphagia” — excessively rapid eating.
Boluses most often consist of poorly chewed meat (the term “backyard barbecue syndrome” has also been applied). The problem tends to occur more frequently in men and often requires an emergency endoscopy, an invasive and expensive procedure which can also be “quite unpleasant” in these situations. Bredenoord said. The stuck food makes it difficult to safely sedate patients. “You have to put the camera through the mouth into the esophagus, and kind of push or pull the piece of food out.”
“These things usually happen in the evenings or nights,” which means an added burden for emergency and on-call endoscopic staff.
An easy solution would be most welcome, he said. “For a long time, people felt cola could play a role here.”
From websites to Wikipedia, people are encouraged to try carbonated beverages, most often Coca-Cola. Bredenoord has heard doctors recommending it. British paramedics once reported saving the life of a man who was choking on a piece of chicken by pouring Coke down his throat.
Previous small studies have reported success rates ranging from 59 to 100 per cent. The first author of the BMJ (formerly British Medical Journal) study, emergency physician Elise Tiebie, saw so many people who had tried cola before they arrived in the emergency department, she decided to test the theory in a more rigorous way.
Tiebie and colleagues randomized 51 adults with a soft food obstruction who arrived at one of five Dutch hospitals from December 2019 to June 2022.
Twenty-eight people were instructed to take regular sips, at one-minute intervals of regular Coca-Cola poured from uncooled cans. Each sip contained 25 ml of the cola. “If four sips proved ineffective, a 10-minute pause followed before continuing the one-minute interval protocol for an additional four sips,” the researchers wrote.
The 23 patients in the control group just waited, without any pre-endoscopic drink or treatment.
Most of the food bolus impactions were caused by meat; others included bread, fries or sauerkraut.
Sixty-one per cent of people in the cola group improved — the food passed completely, or partially. But 61 per cent of the patients who just waited also saw improvement.
Apparently, in a large proportion of people, the food comes loose spontaneously, Bredenoord said. “Cola doesn’t help here,” he said. “It wasn’t clear in the first place why it would help.” Older studies lacked control groups.
While Coke didn’t lead to a higher rate of improvement, the researchers are keeping the option open. The sooner people got to hospital and began sipping cola after the food bolus became lodged, the higher the likelihood of successfully passing it, or “disimpaction.”
The sample size was also relatively small, and there were no big disadvantages to drinking the Coke — there were no adverse events. Cola might be considered a first-line treatment, provided it doesn’t delay endoscopy, the researchers said.
People with a known narrowing of the esophagus often modify their eating behaviour, Bredenoord said. They’re more mindful of how they eat.
That can go out the window during the holidays. People tend to eat more. They eat outside their home with friends and family. “There is sometimes alcohol involved,” Bredenoord said. People aren’t as attentive. They take bigger bites. They don’t chew as long.
Bredenoord’s worst case was an esophagus completely filled with food from bottom to top. A near complete meal.
The researchers don’t believe the lack of effect they saw in the Coca-Cola group was dose related. It’s also unlikely other effervescent agents would help, Bredenoord said.
His advice: “Chew your food well. Eat slowly, and don’t eat and talk at the same time. Eat smaller bites.” The smaller the bites, the smaller the risk of ending up in emergency.
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