Written by Doug Wallace
Spoon Feed
Ever tried having your patient drink Coca-Cola to relieve an esophageal food bolus? This interesting and well-designed multicenter RCT suggests limited efficacy of this off-label approach.
The cold, crisp taste of coke
Esophageal bolus obstructions are commonly seen in EM practice, particularly during the holidays and times of “tachyphagia” as the authors eloquently put it. Standard of care includes emergent endoscopy within 6 hours for persistent complete obstructions, but a number of other approaches including glucagon, nitrates, and even Coca-Cola are sometimes tried before consulting gastroenterology.
This Dutch multicenter RCT enrolled 51 ED patients (28 interventions, 23 controls) to assess the efficacy of up to 200 mL of Coca-Cola in facilitating relief of esophageal food bolus impaction. A few small prior studies suggested using commercially available cola may be a reasonable approach, with carbon dioxide formation thought to aid in clearing obstructions. The primary outcome was improvement of a food bolus obstruction, an aggregate of complete and partial passage.
Partial improvement of bolus impaction listed as being able to swallow saliva was noted in 61% of both study groups. Complete relief of obstruction occurred in 43% of the intervention group versus 35% in the control group. This difference was not statistically significant. Meat was the most common offender in 80% of patients.
How will this change my practice?
This well designed study would seem to indicate Coca-Cola may not be the best choice for esophageal food bolus impactions, within the confines of a small sample size. Next time someone suggests cracking open a can of Coke, I’ll think twice and reference this offbeat paper.
Source
Efficacy of cola ingestion for oesophageal food bolus impaction: open label, multicentre, randomised controlled trial. BMJ. 2023 Dec 11;383:e077294. doi: 10.1136/bmj-2023-077294.
Classic Christmas edition of the BMJ paper! Love the way the editors find fun and interesting papers to fill this one particular edition annually
more interestingly, this is the first time ive seen someone explicitly state 6 hours to endoscopy….oh fun at midnight on my next nightshift
Stupid paper . Of course the author wouldn’t recommend cola for obstruction. No money in prescribing cola!
Well…that and the fact that cola simply didn’t work to relieve esophageal food impaction. This was a RCT. It can demonstrate causality. Coke literally didn’t work compared to control. So, why would they recommend it? That doesn’t sound stupid to me, that sounds like following the evidence.