Use of Glucagon in Relieving Esophageal Food Bolus Impaction in the Era of Eosinophilic Esophagitis

Abstract

Introduction: Esophageal food bolus impaction has an annual incidence of approximately 13 cases per 100,000 per year. To promote the spontaneous passage of the food bolus glucagon is often administered. Glucagon acts by relaxing the smooth musculature of the lower esophagus, thereby reducing the resting pressure of the lower esophageal sphincter. Studies have reported a response in up to one third of the cases who received glucagon, however conflicting data does exist. Eosinophilic esophagitis (EoE) is increasingly recognized as a cause of dysphagia. Food impaction is quite often the presenting symptom (56-86% of the cases). There is little to no data on the effectiveness of glucagon in relieving the esophageal foreign body obstruction in the setting EoE. Methods: Using the ICD codes and the emergency department database, a retrospective chart review of all the patients (≥ 18 years of age) presenting to the emergency department with symptoms of esophageal food bolus impaction from July 2004 to February 2010 was performed. Data collected included age, sex, food type, whether glucagon was given or not, dose of glucagon, response to glucagon, endoscopic findings, dilatation performed, biopsy results, and follow up. Response to glucagon was defined as symptomatic relief of obstruction after receiving glucagon. Endoscopic and pathology reports were reviewed electronically. Results: A total of 193 episodes of esophageal food bolus obstruction were identified during the study period. Glucagon was given in 107 episodes of which 35 had a response (33%). A total of 158 had an EGD performed either during the impaction event or at a later date. Biopsies were taken in 49 of the cases (25.4%). Out of 49 patients who had biopsies, 35 of them had received glucagon (13 with EoE, 22 without EoE). None of the 13 patients with EoE had responded to the glucagon (0%). Seven of 22 without evidence of EoE had responded to glucagon (31.8%, p-value 0.031). Conclusions: Our study shows that glucagon is effective in about one third of patients with esophageal food bolus impaction, which is consistent with historical data. Compared to patients without eosinophilic esophagitis, those with the condition appear to be even less likely to respond to glucagon.