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Twitter debate: controversies in dysphagia
  1. Aditi Kumar1,
  2. Gaurav B Nigam2,
  3. Dipesh Harshvadan Vasant3,4,
  4. Anjan Dhar5
  1. 1Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
  2. 2Translational Gastroenterology Unit, Oxford University Hospitals NHS Trust, Oxford, UK
  3. 3Neurogastroenterology Department, Wythenshawe Hospital, Manchester, UK
  4. 4Division of Diabetes, endocrinology and gastroenterology, The University of Manchester, Manchester, Manchester, UK
  5. 5Department of Gastroenterology, Darlington Memorial Hospital, Durham, UK
  1. Correspondence to Dr Aditi Kumar, Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, West Midlands, UK; aditikumar{at}nhs.net

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Introduction

The final #FGDebate of 2021 discussed controversies in investigating and managing dysphagia. The debate generated over 200 000 impressions with over 70 participants and broadly covered topics of food bolus impaction, eosinophilic oesophagitis (EoE) and oesophageal strictures and briefly touched on dysphagia in scleroderma. In this article, we will expand on the key discussion points from the debate.

Management of food bolus impaction

In our first case, a young man had a turkey bone stuck in his throat. Although he was able to speak, he was struggling to swallow his saliva. We asked our #FGDebate participants whether this patient should first try a fizzy drink, glucagon or head to the emergency department for further assessment. While the majority advised the patient to go to the hospital (80%), others recommended a fizzy drink or glucagon, which led to the discussion of investigations and management of patients with a food bolus obstruction.

Food bolus impactions tend to occur in the oesophagus, with the most common causes being meat pieces or bones in the Western world and fish bones in Asia. The sharp edges of meat bones have a greater chance of perforation than soft food obstructed in the oesophagus. Thus, it is important to arrange either a CT scan or at least a chest X-ray prior to undertaking an oesophago-gastro-duodenoscopy (OGD).1 Ideally, endoscopic assessment should be undertaken within 12–24 hours following impaction to reduce the risk of complications, which include perforation, retropharyngeal abscess and/or fistula formation. Endoscopic assessment should be carried out more urgently, however, if the patient is unable to swallow their saliva. While a trial of glucagon or fizzy drinks is still commonly practised in the emergency department setting, there is limited evidence to support their use and the potential risks of aspiration and/or perforation …

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Footnotes

  • Twitter @dr_dee_kumar, @anjan_dhar6

  • Collaborators Not applicable.

  • Contributors AK conducted the literature review and wrote the main draft of the manuscript. GBN, DHV and AD reviewed and edited the manuscript. All authors approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AK is a trainee associate editor for FG.

  • Provenance and peer review Not commissioned; externally peer reviewed.