Khayyat Yasir Mohammed
Department of Medicine, Umm Al-Qura University, P.O. Box 7607, Makkah, Saudi Arabia.
Emerg Med Int. 2013;2013:924015. doi: 10.1155/2013/924015. Epub 2013 May 13.
Background. Soft esophageal bolus impaction is an emergency that requires skilled endoscopic removal if persistent obstructive symptoms do not resolve spontaneously after careful observation. Expedited care of these patients is crucial to avoid respiratory and mechanical complications. Other possible options for management include medical agents used to manage it prior to performing endoscopy if access to endoscopy was not available or declined by the patient. Aim. To review the available pharmacological and other nonmedicinal options and their mechanism of relief for soft esophageal impaction. Method. Pubmed, Medline and Ovid were used for search of MESH terms pertinent including "foreign body, esophageal, esophageal bolus and medical" for pharmacological and non medicinial agents used for management of esophageal soft bolus impaction as well as manual review of the cross-references. Results. Several agents were identified including Buscopan, Glucagon, nitrates, calcium channel blockers, and papaveretum. Non medicinal agents are water, effervescent agents, and papain. No evidence was found to suggest preference or effectiveness of use of a certain pharmacological agent compared to others. Buscopan, Glucagon, benzodiazepines, and nitrates were studied extensively and may be used in selected patients with caution. Use of papain is obsolete in management of soft bolus impaction.
背景。软性食管团块嵌塞是一种急症，如果在仔细观察后持续性梗阻症状未自行缓解，则需要熟练的内镜下取出。对这些患者进行快速治疗对于避免呼吸和机械并发症至关重要。其他可能的处理选择包括，如果无法进行内镜检查或患者拒绝内镜检查，则在进行内镜检查之前使用药物来处理。目的。回顾用于软性食管嵌塞的现有药物及其他非药物选择及其缓解机制。方法。使用PubMed、Medline和Ovid检索相关医学主题词，包括“异物、食管、食管团块和药物”，以查找用于处理食管软性团块嵌塞的药物及非药物制剂，并人工查阅参考文献。结果。确定了几种药物，包括丁溴东莨菪碱、胰高血糖素、硝酸盐、钙通道阻滞剂和罂粟碱。非药物制剂有水、泡腾剂和木瓜蛋白酶。没有证据表明与其他药物相比，某种药物的使用更具优势或更有效。丁溴东莨菪碱、胰高血糖素、苯二氮䓬类药物和硝酸盐已得到广泛研究，谨慎使用时可用于特定患者。木瓜蛋白酶在软性团块嵌塞的处理中已过时。
