• Steakhouse Syndrome

    (Esophageal Food Bolus Obstruction; Syndrome, Steakhouse)

    Definition

    Steakhouse syndrome is a condition in which a mass of food (called a bolus) becomes stuck in the lower part of the esophagus. The esophagus is the muscular tube that carries food and liquids from the mouth to the stomach.
    This condition can be easily treated. Contact your doctor if you think you may have steakhouse syndrome.
    The Esophagus
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    Copyright © Nucleus Medical Media, Inc.

    Causes

    This condition happens when a mass of food, usually meat, blocks the passageway of the esophagus.

    Risk Factors

    Risk factors include:
    • Not chewing your food completely
    • Drinking too much alcohol
    • Wearing dentures
    • Having a physical problem that affects how food moves down the esophagus
    • Having a condition that affects the esophagus, such as:
      • Schatzki's ring—ring of tissue that forms in the lower part of the esophagus
      • Esophageal stenosis—narrowing of the esophagus caused by scar tissue
      • Hiatal hernia —upper part of the stomach moves up through a small opening into the chest
      • Eosinophilic esophagitis—chronic inflammation in the esophagus
      • Esophageal cancer or other tumors

    Symptoms

    Symptoms may include:
    • Chest pain
    • Difficulty swallowing
    • Drooling
    • Coughing, gagging, choking
    These symptoms may be due to other conditions. If you have any of these symptoms, talk to your doctor.

    Diagnosis

    Your doctor will:
    • Ask about your symptoms and medical history
    • Do a physical exam
    • Order tests, such as:
      • X-ray with or without barium (a chalky liquid used to coat the organs so they can be easily seen on x-ray)
      • Endoscopy —a thin, lighted tube inserted down the throat to examine the esophagus

    Treatment

    If the bolus does not pass into the stomach on its own, your doctor may consider treatment, such as:
    • Drinking a carbonated beverage to help move the bolus into your stomach
    • Giving a substance called glucagon by an injection—This will decrease the pressure in your esophagus, allowing the bolus to pass into your stomach.
    If the bolus still does not pass, the doctor may remove it from your esophagus. She will use an endoscope to locate the bolus. Once the bolus has been found, tools (eg, snares, forceps, net) are passed down the endoscope to remove the bolus. In some case, the bolus may move into the stomach during the procedure.
    Often, the doctor will also look for underlying conditions that may have put you at risk for this problem.

    Prevention

    To help reduce your chance of getting steakhouse syndrome, take the following steps:
    • Chew slowly and until the food is small enough to safely swallow.
    • If you have been diagnosed with a condition that affects your esophagus, get proper care for it.

    RESOURCES

    American Academy of Otolaryngology—Head and Neck Surgery http://www.entnet.org/

    The American College of Gastroenterology http://www.acg.gi.org/

    CANADIAN RESOURCES

    The Canadian Association of Gastroenterology http://www.cag-acg.org/

    Canadian Society of Otolaryngology http://www.entcanada.org/

    References

    Belafsky PC, Postma GN, Koufman JA. Steakhouse syndrome in a man with a lower esophageal ring and a hiatal hernia. Ear Nose Throat J. 2003;82(2):102.

    Chae HS, Lee TK, Kim YW, et al. Two cases of steakhouse syndrome associated with nutcracker esophagus. Dis Esophagus. 2002;15(4):330-333.

    DiPalma JA, Brady CE III. Steakhouse spasm. J Clin Gastroenterol. 1987;9(3):274-278.

    Esophageal food bolus obstruction (steakhouse syndrome). National Center for Emergency Medicine Informatics. Available at: http://www.ncemi.org/cse0602.htm . Accessed November 22, 2010.

    Stadler J, Hölscher AH, Feussner H, Dittler J, Siewert JR. The "steakhouse syndrome." Primary and definitive diagnosis and therapy. Surg Endosc. 1989;3(4):195-198.

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