The efficacy of fruit juices in disimpacting meat bolus obstruction

Abstract

Problem: Impacted meat bolus in the oesophagus carries an increased risk of morbidity and mortality if it requires retrieval by endoscopic procedures. Certain naturally occurring fruit juices and Coke have been implicated to dissolve meat boluses but without conclusive evidence. This study aimed to ascertain the efficacy of various fruit juices and Coke in dissolving and dislodging meat boluses in vitro. Methods: Eighty 10 mL syringes were modified by removing the tapered ends and pistons. Boiled chicken meat was tightly packed between the 8 mL and 10 mL markers of each syringe. Syringes were positioned vertically with the 10 mL marker above. Two mL each of 8 reagents (fresh pineapple juice (FPJ), frozen-thawed fresh (FTPJ), fresh kiwi juice (FKJ), commercially pasteurized pineapple juice, fresh papaya juice, fresh lemon juice, Coke, and saliva) were poured over the bolus of each syringe, thus dividing them equally into 8 separate groups (n = 10 in each group). Bolus movements were observed over a 23-hour period at 37°C ambient temperature. Movements were noted by recording the upper border of the meat bolus periodically in arbitrary syringe units. Results: At 4 hours and 30 minutes, mean movements (99% CI) for the FPJ, FTPJ, FKJ groups were 3.4 (1.2–5.6), 4.5 (0.9–8.0), and 3.9 (1.1–6.8), respectively. At 23 hours, they were 1.3 (0.6–2.1), 0.3 (0–1.1), and 0.9 (0.5–2.3), with the saliva group (control) being 9.5 (8.9–10.1). The differences in the mean bolus movement between FPJ, FTPJ, FKJ, and saliva were 8.15 (7.1–9.2), 9.15 (8.1–10.2), and 8.55 (7–10.1), respectively. Mann-Whitney U test showed P < 0.001 for all 3 groups. The papaya and Coke groups showed some bolus movement but did not reach statistically significant levels. Conclusion: Fresh pineapple and kiwi fruit juices, which contain proteolytic enzymes bromelain and actinidin respectively, appeared to dissolve chicken boluses effectively. The freezing process for 24 hours preserved Bromelain activity. Significance: Natural pineapple and kiwi fruit juices may be used to disimpact chicken bolus obstruction prior to endoscopic procedures. Support: We wish to thank Mr Bijoux and his team of microbiologist technicians at the Department of Medical Microbiology, Duncan Building 8th floor, University of Liverpool, UK, for their support.