Last reviewed:September 2019
Last updated:November  2018

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • dysphagia
  • non-specific abdominal pain
  • stridor and wheezing
  • drooling

Other diagnostic factors

  • gagging, nausea/vomiting, neck/throat pain
  • atypical chest pain or non-cardiac chest pain
  • choking
  • signs of upper gastrointestinal obstruction
  • lower gastrointestinal bleeding
  • odynophagia
  • fever, poor feeding, failure to thrive, and irritability (in children)
  • acute or chronic asthma-like symptoms or recurrent pneumonia
  • signs of sepsis
  • sign of acute drug intoxication

Risk factors

  • age <15 years
  • male sex (adults)
  • gastrointestinal tract narrowing
  • mechanical disorders of the gastrointestinal tract
  • chemical dependence
  • intellectual disability
  • mental illness
  • inmates or people engaged in criminal activities
  • dental disorders
  • hurried eating
  • impaired gag reflex
  • history of underlying oesophageal disease, surgery, or procedure
  • seizure disorder

Diagnostic investigations

1st investigations to order

  • x-rays of neck, chest, abdomen
  • FBC
  • urea and electrolytes
  • prothrombin time/INR
  • PTT
  • oxygen saturation
  • faecal occult blood testing
  • hand-held metal detector
Full details

Investigations to consider

  • cardiac biomarkers
  • ECG
  • CT of neck, chest, and/or abdomen
  • MRI
  • laryngoscopy
  • endoscopy
Full details

Treatment algorithm

Contributors

Associate Professor

Department of Emergency Medicine

GW School of Medicine & Health Sciences

Center for Healthcare Innovation and Policy Research

Washington

DC

Disclosures

ACM declares that he has no competing interests.

Dr Andrew C. Meltzer would like to gratefully acknowledge Dr Juan Carlos Munoz and Professor Luis F. Laos, previous contributors to this topic.

Peer reviewersVIEW ALL

Consultant

Ganesh Man Singh Memorial Academy of ENT and Head and Neck Studies

TU Teaching Hospital

Maharajgunj

Kathmandu

Nepal

Disclosures

PA declares that he has no competing interests.

General Surgery Chief Resident

Department of General Surgery

University of Tennessee Medical Center

Knoxville

TN

Disclosures

JFA declares that he has no competing interests.

Clinical Research Fellow

Cleveland Clinic Florida

Weston

FL

Disclosures

RVS declares that he has no competing interests.

Associate Professor of Pediatric Surgery

University of Pittsburgh School of Medicine

Pittsburgh

PA

Disclosures

DJH declares that he has no competing interests.

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