What is Steakhouse Syndrome or Esophageal Food Bolus Obstruction?

Steakhouse Syndrome or Esophageal Food Bolus Obstruction is a condition which occurs when any foreign body or a food bolus does not pass through the esophagus and instead becomes stuck in its lumen. Steakhouse Syndrome or Esophageal Food Bolus Obstruction is a medical emergency and is named thus because meats, such as steak, pork or poultry are the common foods which are responsible for the occurrence of this syndrome.

What is Steakhouse Syndrome

Steakhouse Syndrome or Esophageal Food Bolus Obstruction is identified when the patient develops sudden difficulty in swallowing, which prevents the food from passing through the esophagus and gets lodged in the lumen of the esophagus and requires immediate medical attention. Adults more commonly develop Steakhouse Syndrome or Esophageal Food Bolus Obstruction although children can suffer from it too. There is a direct association between Steakhouse Syndrome or Esophageal Food Bolus Obstruction and episodes of food ingestion.

Treatment for Steakhouse Syndrome or Esophageal Food Bolus Obstruction depends on the specific characteristics of the obstruction. Medications can help resolve the problem in some cases, whereas, endoscopy may be necessary to either remove the food bolus from the esophagus or to push it into the stomach.

Causes of Steakhouse Syndrome or Esophageal Food Bolus Obstruction

Steakhouse Syndrome or Esophageal Food Bolus Obstruction commonly occurs as a result of diseases which narrow the esophageal lumen and can be an indication of an underlying motility disorder or a mechanical problem. In recent studies, it was also seen that a great number of patients suffering from Steakhouse Syndrome or Esophageal Food Bolus Obstruction also have esophageal pathology. Some of the syndromes which are usually associated with Steakhouse Syndrome or Esophageal Food Bolus Obstruction include Schatzki ring, nutcracker esophagus, esophageal stricture, esophageal webs, achalasia, eosinophilic esophagitis and esophageal malignancy.

Steakhouse Syndrome or Esophageal Food Bolus Obstruction is less common in children, and when and if it occurs, then anatomical disorder of the esophagus is not its common cause. In children common causes of Steakhouse Syndrome or Esophageal Food Bolus Obstruction include behaviors, such as eating quickly or very fast and wolfing down food without chewing it properly. Other than this, eosinophilic esophagitis is also being recognized as the most common cause of dysphagia, which is associated with obstruction in young men and children.

Symptoms of Steakhouse Syndrome or Esophageal Food Bolus Obstruction

Patient suffering from Steakhouse Syndrome or Esophageal Food Bolus Obstruction experiences sudden dysphagia, which is difficulty in swallowing/choking, drooling, chest painodynophagia (painful swallowing), abdominal pain, neck pain, heartburngastroesophageal reflux disease (GERD) and asthma.

Diagnosis of Steakhouse Syndrome or Esophageal Food Bolus Obstruction

The symptoms experienced by the patient of sudden and acute difficulty in swallowing along with one or more of the above mentioned symptoms in combination with an episode of food ingestion or swallowing a foreign object makes a strong case for diagnosis of Steakhouse Syndrome or Esophageal Food Bolus Obstruction. To confirm the diagnosis, endoscopy is the standard method of choice.

Treatment of Steakhouse Syndrome or Esophageal Food Bolus Obstruction

Steakhouse Syndrome or Esophageal Food Bolus Obstruction is a condition where there is obstruction in the lumen of the esophagus and this could be a potentially serious problem. The aim of treatment of Steakhouse Syndrome or Esophageal Food Bolus Obstruction in majority of the cases is to manage the patient medically, such that there is resolution of the obstruction.

Treatment for Steakhouse Syndrome or Esophageal Food Bolus Obstruction depends on the specific characteristics of individual patient, such as the nature of the object, which is causing obstruction. If the obstructing object has sharp edges as seen in a bony object or if it is of a corrosive nature, such as batteries then it needs to be removed ASAP. Rigid esophagoscopy is the standard removal method in such cases and is done under general anesthesia. In other cases, where the esophageal obstruction is due to non-sharp food bolus, then it can eventually pass spontaneously.

Techniques for Spontaneous Resolution: There are various techniques which have been put forward to induce spontaneous resolution of the obstruction instead of going for endoscopy. These techniques comprise of a "push technique," which consists of blind insertion of nasogastric tubes and Maloney dilators in order to push the food bolus/object into the stomach. This is known as the "push technique." Another method for treating esophageal obstruction is by inserting the Foley's catheter for extracting the foreign body.

Pharmacological Techniques: Medicines can also be used for resolving the esophageal obstruction. These consist of agents that change the muscular tone of the esophagus thus permitting the food bolus or foreign body to pass through. Enzymatic digestion of the bolus can be achieved by the use of carbonated drinks, such as Coca-Cola, or mixtures of sodium bicarbonate and citric acid solutions.

Endoscopic Removal: If the obstruction is not resolved through medical management, then it becomes necessary for endoscopic removal using either flexible or rigid techniques. There is a wide array of endoscopic devices, such as Dormia baskets, rat-tooth forceps, polypectomy snares, and Roth net of different sizes can be used for surgical removal of the obstruction. Roth nets are especially useful if the obstruction occurs as a result of food boluses, as they can be caught in its entirety within the net without the use of general anesthesia or an overtube, thus minimizing the risk of aspiration.

Prevention of Steakhouse Syndrome or Esophageal Food Bolus Obstruction

Steakhouse Syndrome or Esophageal Food Bolus Obstruction can be prevented by chewing food properly before swallowing (especially meat) and avoiding swallowing large chunks of food. Other than this, various underlying medical conditions can also contribute to narrowing of the lumen of the esophagus, which in turn increases the risk of Steakhouse Syndrome or Esophageal Food Bolus Obstruction. Therefore, it is important that the patient be carefully monitored and treated for these conditions on time. Stomach acid reflux to the esophagus can cause inflammation and scarring. This condition is known as acid peptic stricture where there is a fibrous scar which contracts and causes narrowing of the esophageal opening. Treatment with acid-suppressive therapy using proton pump inhibitors helps in keeping the symptoms under control along with preventing a steakhouse syndrome or Esophageal Food Bolus Obstruction.

Accidental ingestion of foreign body is another common cause of esophageal obstruction, especially in children who are between the ages of 6 months to 3 years. It is important to carefully monitor the children during this stage and prevent them from reaching the objects which can be a threat. Very young children are at an increased risk for swallowing caustic agents, such as liquid lye which can cause severe burns to the esophagus resulting in narrowing of the esophageal lumen and its obstruction. It is therefore important to store such kind of chemicals carefully away from the reach of the children.

Prognosis of Steakhouse Syndrome or Esophageal Food Bolus Obstruction

Most of the esophageal obstruction can resolve spontaneously or with the use of medical management without any medical consequences. About 10 to 20% of the patients suffering from Steakhouse Syndrome or Esophageal Food Bolus Obstruction need endoscopic intervention, and around 1% of patients may need surgery eventually. During surgery, there is a risk of tear and minor lacerations to the wall of the esophagus, as it is very thin. There can be some amount of local bleeding also. Some of the potentially serious complications, such as mediastinitis and esophageal perforation can occur. If the causes of steakhouse syndrome or esophageal food bolus obstruction are long and sharp foreign bodies, then they should be immediately removed and should not be allowed to pass from the stomach to the intestine, as this can cause intestinal perforation. One of the serious complications of steakhouse syndrome or esophageal food bolus obstruction is acute mediastinitis, which has a mortality rate of 30 to 40 %. There is an increased risk of complications if the steakhouse syndrome or esophageal food bolus obstruction lasts for more than 24 hours.

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Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: March 15, 2017

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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