What is Gastrointestinal Foreign Body?
Foreign object or food blockages are some of the most common stomach and intestine-related problems seen in emergency rooms. They can occur in both adults and children. Usually, these foreign objects pass through the body naturally without any intervention in 80 to 90% of cases. When someone comes into the hospital with this problem, the job of the healthcare worker is to figure out which patients are at high risk for complications. These patients will need immediate medical attention.
What Causes Gastrointestinal Foreign Body?
Most of the time, when people accidentally swallow foreign objects, they pass through the body without anyone ever realizing it or needing to go to a doctor. Usually, if adults do end up needing medical attention for a swallowed object, they’re already experiencing symptoms by the time they get to a clinic or emergency room. However, children tend to get medical help because their parents or family members saw them swallow the object.
Usually, if a swallowed object makes it to the stomach, it tends to continue its journey through the digestive system and leave the body naturally without needing any medical intervention. However, problems can arise depending on what kind of object was swallowed, how many were swallowed, where the object gets stuck, and how long ago it was swallowed.
The most common problem that can occur is when the swallowed object gets stuck, usually in the esophagus. Certain spots in the esophagus are narrower than others and objects can more easily get stuck there. These are usually near the top where a muscle called the cricopharyngeus is located, near the aortic arch, and where the esophagus connects to the stomach. If an object is stuck in these spots, it might show up on an X-ray near the collarbones, a spot in the lung called the carina, and just above the area where the stomach creates a pocket of air, respectively.
If an adult has a pre-existing condition that affects the esophagus, like eosinophilic esophagitis, strictures, or cancer, objects might also get stuck at the spot where the esophagus is abnormal. Furthermore, any swallowed object that is too long to pass through a part of the stomach called the pylorus would also be unlikely to leave the body naturally.
Risk Factors and Frequency for Gastrointestinal Foreign Body
Both adults and children can experience the issue of swallowing foreign objects or getting food stuck in the throat. However, children, especially those between 6 months to 6 years of age, are more likely to swallow foreign objects as they are in the process of exploring their world. The risk increases due to their tendency to handle things, and they often end up swallowing small objects like coins or shiny balls. Other objects that pose a high risk include button batteries, strong magnets (neodymium magnets), and anything sharp or pointed.
Mental or cognitive impairments, as well as neglect, also contribute to cases of swallowing foreign objects or repetitive incidents of the same. In cases where older individuals or unusual objects are involved, other factors such as mental health issues, self-harm, eating disorders like bulimia, or drug smuggling may need to be considered.
On the other hand, choking on food is more common among adults, particularly those who already have complications related to the esophagus, such as achalasia, diverticula, webs, and strictures. Other factors that can increase this risk among adults are self-harm, alcohol or substance misuse, lack of natural teeth or usage of dentures. In addition, elderly people with poor vision can sometimes mistake small objects for medication and end up swallowing them.
Signs and Symptoms of Gastrointestinal Foreign Body
When children swallow or inhale foreign objects, their symptoms can vary greatly. In most cases, they might not show symptoms at all or might complain about minor discomforts like a sore throat, chest discomfort, or feeling as though something is stuck in their throat. The more serious symptoms arise due to complications. If the foreign object gets stuck, they might experience difficulty in swallowing, pain during swallowing, undesire to eat, and trouble in handling saliva.
It’s important to get information about what and how many objects were swallowed and when it happened. You should also ask about the details of the incident and whether such incidents have happened before. Repeated cases might be due to neglect or abuse or could suggest cognitive or mental disorders. Objects that can cause severe harm are batteries, magnets, and sharp or pointed objects. Sharp objects can possibly puncture and lead to leakage of stomach content leading to inflammation or infections. Button Batteries can cause severe tissue damage and burns. If someone swallows magnets or a combination of a magnet and other metallic items, they may experience symptoms like blockage of the bowel, twisted intestine, or inflammation.
Adults usually have food stuck in their throat more frequently than any foreign body. Their symptoms are mostly similar to those in children and include a feeling of a lump in the throat, difficulty in swallowing, and chest pain. It is crucial to know what they swallowed, when it happened, and their capacity to eat post the incident. It is also important to understand their medical history, especially if they have any throat diseases or a history of food getting stuck.
Oftentimes, a physical examination might not show anything significant because these patients usually do not have symptoms or have very mild symptoms. Firstly, the healthcare provider will check your airway and breathing. However, a foreign body stuck in the back of the throat is rare but the area should still be checked. Excessive saliva in the mouth might be seen. Discomfort in swallowing liquids and drooling could indicate blockage of the esophagus that needs immediate endoscopy. Pediatric patients should also have their ears and nose examined for foreign bodies. If a patient is in shock, breathing heavily, and in respiratory distress, it could mean that the foreign body has punctured through.
Testing for Gastrointestinal Foreign Body
If someone might have swallowed a foreign object, the first step is usually an X-ray. 83% of things people swallow show up on an X-ray. But, the X-ray might not always spot smaller objects, or objects in thicker parts of the body. X-rays of the front and side of the neck, chest, or abdomen may help doctors spot the swallowed object. Sometimes, a radiolucent item won’t show up directly on an X-ray but may cause the edges or shapes on the X-ray image to look weird.
If someone has swallowed a small battery – like the kind used in watches – doctors usually suggest an X-ray for children under 12. If someone older has swallowed a bigger battery, roughly the size of a penny or larger, then an X-ray makes sense too. You can usually tell a battery from a coin on an X-ray because the battery has a double-ring shadow.
Using a handheld metal detector can be helpful in figuring out where in the body the swallowed object is. An X-ray is helpful at first to see if the object is high-risk, but if doctors are just waiting for the object to naturally pass through the digestive system, a metal detector can track its progression without needing more X-rays.
Remember, if someone is feeling bad – like chest or stomach pain or feeling sick or throwing up – doctors might need to run more tests to make sure something else isn’t wrong. If it looks like the swallowed object might be stuck in the esophagus, doctors don’t need more scans to find out exactly where it is – it’s important to get it out quickly with an endoscopy.
Treatment Options for Gastrointestinal Foreign Body
When a foreign object is found in the digestive system, plans can be made on how to handle the situation. If the object isn’t dangerous and has made it to the stomach, it will likely pass naturally through the digestive system without needing any medical help. In this case, parents are typically advised to look out for the object when their child goes to the bathroom. If the child accidentally swallowed a small battery, and they’re showing no signs of discomfort, they can also be managed at home in the same way. In both situations, parents should watch their kids for any signs of blockage in the digestive system or injury.
However, if the battery is in the esophagus when a child comes to the hospital, a quick examination with an endoscope is needed as the damage can begin in just 2 hours. If a child swallows multiple magnets, or a magnet and another piece of metal together, they need immediate treatment. These magnets can pull towards each other through the walls of the digestive system and cause serious problems. Children showing signs of blockage, inflammation of the peritoneum (the lining of the abdomen), or a tear in their digestive system need to go to the operating room immediately. It’s important to note that the drugs glucagon and diazepam should not be used in kids in these cases because they can induce vomiting, which could lead to the kid breathing in the vomit.
For adults who have possibly swallowed and gotten food stuck, they can be tried on medication; however, a similar endoscopy procedure is often needed. Complications can arise based on where the foreign body is and how long it has been in the body. If foreign bodies are in the esophagus, they can damage the mucous membrane and weaken it, increasing the risk of bleeding and tears. Because of this, they should be removed as soon as possible.
The American Society for the Gastrointestinal Endoscopy Committee suggests that people who have foreign bodies suspected to be at or above the level of a muscle in your throat called the cricopharyngeus muscle should consult with ear, nose, and throat specialists. They state that there’s varying success with using glucagon to relieve the discomfort caused by food blockage. Glucagon can decrease the tension at the lower esophageal sphincter (a circular muscle layer at the base of the esophagus) and can help relieve the blockage but may also induce vomiting which can cause tearing and further blockage.
Studies indicate that glucagon successfully relieves food blockage in one third of cases and that initial treatment with glucagon is cheaper than an initial treatment with an endoscope. The older a patient is and the earlier they come to the emergency department are independent factors indicating a foreign body could be present. One explanation is that older individuals may have a decreased ability to move food through their esophagus naturally, making it harder for a foreign body to be passed.
Patients with difficulty swallowing and pain may have a foreign body in the upper third of their esophagus. In these cases, food blockages are generally found in the lower third of the esophagus, mostly in older patients or patients with psychological disorders. For these patients, an immediate endoscopy is usually recommended. However, for younger patients who are not showing any symptoms, observation or a trial of medication may be considered as an initial option.
What else can Gastrointestinal Foreign Body be?
When someone comes to a doctor because they swallowed something they shouldn’t have or they feel like they have a lump in their throat, the doctor will naturally think of these incidents first. However, there are other health conditions that could cause similar symptoms. These can include:
- Inflammation of the esophagus (esophagitis)
- Inflammation of the back of the throat (pharyngitis)
- Inflammation of the voice box or windpipe (laryngitis)
- Abscesses or pus-filled infections near the tonsils or back of the throat
- Acid reflux disease (GERD)
- Heart disease, such as acute coronary syndrome, in adults
- Stomach inflammation (gastritis)
- Slow emptying of the stomach (gastroparesis)
- Narrowing of the lower stomach opening (pyloric stenosis)
These are important conditions that the doctor will consider and run tests for, to make sure they come to the right diagnosis.
What to expect with Gastrointestinal Foreign Body
Most of the time, foreign objects pass through the body on their own, without needing any treatment, and only 1% might cause a tear or hole. Foreign objects with sharp edges have a high risk of causing such damage. Such perforations commonly happen in narrower parts of the gastrointestinal (digestive) tract. It’s crucial to identify and treat these cases promptly, mainly when the foreign body lodges in unusual places, to improve the outcome.
However, up to 10% of deaths have been reported due to late or missed diagnoses. It underscores the importance of timely detection and treatment in such scenarios.
Possible Complications When Diagnosed with Gastrointestinal Foreign Body
The severity of complications following ingestion of a foreign object or food getting stuck in the esophagus depends on various factors such as the type of object swallowed, where it’s located, and how much time has passed since it was swallowed. One of the main worries about such scenarios is the pressure the foreign body puts on the inner lining of the esophagus. This could lead to swelling, weakening of the esophageal walls, and an increased risk of bleeding and rupturing.
For instance, when button batteries, which react with other substances, get stuck in the esophagus, they can cause serious tissue damage and chemical burns from the buildup of sodium hydroxide. There is also a risk of creating an abnormal connection with large blood vessels, which may result in severe bleeding, and in extreme cases, death. This damage can start as soon as 2 hours after swallowing the battery.
Swallowing multiple magnets or a magnet along with other metallic objects also causes complications. The magnets could attract each other through different layers of the bowel wall, leading to blockage, twisting of the intestines, and the formation of abnormal connections. Conditions like tissue death, perforation, and inflammation of the thin tissue lining the inside of the abdomen may incur. Sores from deep pressure can also develop within the first 8 to 24 hours after swallowing the magnets.
Common Side Effects:
- Swelling and weakening of the esophageal walls
- Increased risk of bleeding and rupturing
- Serious tissue damage and burns with swallowing button batteries
- Risk of severe bleeding or death if the battery creates abnormal connections with large blood vessels
- Blockage, twisting of the intestines, and the formation of abnormal connections with swallowing magnets
- Risk of tissue death, perforation, and inflammation of the abdomen
- Potential formation of sores from deep pressure.
Preventing Gastrointestinal Foreign Body
Parents should be informed about the risks of leaving batteries and magnets within easy reach of young children at home. It’s crucial that they understand the importance of seeking immediate medical attention if they suspect their child has swallowed any of these items. If a child shows no signs of discomfort after swallowing a coin or small object, parents can be advised that it’s safe to keep an eye on the child at home and check their waste over the next 10 to 14 days to make sure the object has passed.
Adults who have food stuck in their throat, especially older adults, should receive medical attention because it’s less likely that the stuck food will pass on its own. This is due to a decrease in the strength of throat muscles with age. People with cognitive impairments need constant supervision to avoid accidental swallowing of foreign objects.
