My husband and I experienced our first visit to the Emergency Room in February. We did not expect our dinnertime to be interrupted in this way.

On Wednesday, February 23, Greg and I were having dinner at home around 7:30 when he started experiencing some discomfort. He’s had a history of indigestion, so I gave him some Pepto and we both thought that the sensation would pass in a few minutes the way it normally does. However, the discomfort transitioned into full chest pain and it was progressing for almost an hour. It got so bad that he couldn’t even swallow. He found himself spitting into napkins because his own saliva wasn’t making it down. He would feel a little better after a belch, but it was only a moment of relief before the pain started again. We got to the ER at 9 p.m. and hoped to get to the bottom of this quickly.

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He was seen right away and the EKG and blood pressure all came back normal. We were sent back to the waiting room when he began vomiting a clear liquid. This was scary because this has never once happened before when he experienced heartburn.

We were moved to a room a while later and the doctor came to check on him shortly after that. Greg was quickly diagnosed with an esophageal food bolus impaction. Commonly referred to as “Steakhouse Syndrome,” this is a condition in which food gets lodged in the esophagus after inadequate chewing.

This usually occurs with steak or other meats that are tougher to chew and therefore aren’t small enough to pass to the digestive system. Unfortunately for Greg, we had lemon-pepper chicken on the menu that night, and it is most likely what caused his issue.

In telling of this incident to our family members and close friends, we realized that not many of them had ever heard about this before. Greg allowed me to recount this experience to help others identify the symptoms and take action if needed. I reached out to Southcoast Health for more information.

What Are the Symptoms of Food Bolus Impaction/Steakhouse Syndrome?

Dr. Dani Hackner is the Chief Clinical Officer for Southcoast Health. He explained that food bolus impactions are acute events that cause immediate, noticeable discomfort.

“They occur by moving ‘forward’ to the stomach or ‘backward’ resulting in regurgitation,” Hackner said. “When symptoms persist, they cause substantial chest pain and discomfort. Patients report squeezing in the chest that can be difficult to distinguish from a heart attack. But importantly, the pressure is associated with the inability to swallow secretions that produce excessive salivation. This reflects esophageal obstruction.”

In contrast to choking, breathing is not impaired in food bolus impaction.

What Risk Factors Can Cause Food Bolus Impaction?

Hackner states that the Food Bolus Impaction generally arises from underlying issues with the esophagus in two categories: mechanical issues and functional problems.

Mechanical issues include strictures, Schatzki rings, scarring, lower esophageal sphincter/GE junction. Functional problems include motility disorders, esophageal spasms, neurologic disorders, medication-related infections/esophagitis.

“Other contributing factors include poor dentition, ill-fitting dentures, use of alcohol, or eating rapidly. An important differential diagnosis is acute foreign body ingestion. This requires a good history by the physician. Radiology is sometimes required to rule out an associated condition, such as esophageal perforation.”

Can a Food Bolus Impaction Be Treated at Home?

Hackner suggests that acute dysphagia associated with food bolus impaction with clear symptoms can sometimes be managed at home with positioning, relaxation, or time.

When Should Someone Seek Medical Care for Food Bolus Impaction?

Persistent or severe food bolus impaction may require emergency intervention including imaging to rule out perforation.

“Because Food Bolus Impaction resembles some other life-threatening events, do not wait and do come into the emergency department if symptoms do not resolve quickly,” Hackner said. “Delaying care of Food Bolus Impaction by 12 to 24 hours can also worsen outcomes and lead to complications.”

What Treatment Can Be Performed at the Emergency Room for Food Bolus Impaction?

At the emergency room, medications can be given by the emergency physician to try and relax the esophagus and help relieve the obstruction.

“If that doesn't work, gastroenterology specialists may be called to assess and perform an endoscopy to relieve the impaction by either grasping or pushing gently,” Hackner said. “Southcoast gastroenterology provides care at all three hospitals for acute GI emergencies.”

What Should Someone Do After a Food Bolus Impaction Incident As a Follow-Up?

The most important step is for individuals who have had one or more episodes of Food Bolus Impaction to follow recommendations to prevent another episode.

“All should make sure to take small bites and fully chew their food, especially hard foods such as meats and hard vegetables,” Hackner said. “Please follow up with your PCP and GI to manage any underlying conditions such as dysmotility that may have caused it.”

The Aftermath of Greg’s Episode

Greg’s treatment included an IV of glucagon to relax the contracted esophagus and allow the food to pass through the widened space. After a couple of hours, he was good as new. His doctor referred him to a gastroenterologist for a follow-up to understand the potential cause and prevent it from happening again.

If you are eating and suddenly feel intense indigestion/heartburn/chest pain with excessive saliva and have trouble swallowing, you may have a small piece of food that has lodged itself in the esophagus. Try to stay calm, but if the pain persists or worsens, head to an ER and describe these symptoms thoroughly. You could be feeling better in no time.

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