This article was written by sysoon
When a large piece of food gets stuck in the esophagus, causing dysphagia and chest pain, the doctor gives a treatment recommendation to drink a can of Coke first?
This is no joke, in recent years, several studies have shown that the success rate of relieving the obstruction of food masses in the esophagus by drinking cola ranged from 59% to 100%, and there were no short-term adverse events (esophageal perforation, mucosal tear, bleeding, aspiration, etc.). [1~4]
A group of researchers shocked by these findings decided to conduct their own trial to see if Coke actually had this miracle effect, and published the results in this year's BMJ Christmas issue.
Source: The BMJ
Can cola cure esophageal obstruction?
According to current recommendations from the United States (ASGE) and the European Society for Gastrointestinal Endoscopy (ESGE), urgent endoscopy is required within 6 hours for patients with complete esophageal food mass obstruction, and within 24 hours for patients with partial esophageal food mass obstruction, and patients do not need preendoscopic treatment while waiting for emergency endoscopic removal.
If Coca-Cola is really as the previous research says, it can be an effective treatment for esophageal food mass obstruction. Cheap and ubiquitous Coke can save patients from going to the emergency room, endoscopy and treatment.
A certain person is planning his own food hoarding
Therefore, to compare the efficacy of Coca-Cola as a preendoscopic treatment with the current standard of care in the ESGE guidelines (i.e., no need for preendoscopic treatment while waiting for emergency endoscopic removal), the research team invited 51 emergency adult patients (18 years of age and older) with complete esophageal food mass obstruction to participate in the trial. (Note: Complete food bolus impaction: Sensation of food trapped between the oropharynx and upper abdomen when attempting to swallow, and sudden complete inability to swallow saliva.) ）
These patients were admitted to 5 hospitals and their obstruction was largely caused by soft foods such as meat (without bones), bread, chips, and kimchi, and were randomly divided into intervention and control groups in this open-label, multicenter randomized controlled trial.
During the course of treatment, patients in the intervention group were required to drink 25 ml of Coca-Cola every minute up to a maximum of 8 times (200 ml, a mini can of Coca-Cola). If the patient's symptoms are not relieved after 4 drinks, pause for ten minutes and continue drinking 25ml every one minute. Throughout the procedure, patients are immobilized to drink cola in an upright or sitting position and can withdraw from the study at any time. The control group did not receive any preendoscopic therapy.
If the symptoms of the two groups are not completely relieved in the end, endoscopic removal therapy is still carried out according to the existing conventional clinical treatment standards. (Removed within 6 hours for patients with complete obstruction and within 24 hours for patients with partial obstruction).
Participant flow chart, image source [5]
The results showed that a can of mini cola did not show miraculous results: the pass rate of complete food balls was 43% (n=12) in the intervention group and 35% (n=8) in the control group (1.4 (0.45 ~ 4.4); −0.23 (−1.5 ~ 0.39); p=0.58 (complete pass: complete elimination of symptoms, able to pass through saliva), 18% (n=5) of patients in the intervention group partially passed the food bolus, compared to 26% (n=6) in the control group.
That is, in this study, cola consumption did not increase the rate of improvement in complete esophageal food mass obstruction.
It doesn't work wonders, but it's still recommended
But the can of Coke that I drank was not useless.
According to the research team, given that there were no esophageal perforations, mucosal tears, bleeding, aspiration, or any other adverse events requiring treatment or leading to long-term hospitalization in the intervention group, and that the associated symptoms were relieved after treatment, cola could still be considered as first-line therapy, but this should not delay any endoscopic management plan.
Research teams have differed on the effectiveness of cola in the treatment of esophageal food obstruction or esophageal strictures, and the rationale for its treatment has not yet been clarified.
In an observational study of healthy volunteers drinking cola, it was found that the lower esophageal sphincter pressure decreased after the volunteers drank cola, which may be related to the acceleration of the rapid transport of food through the esophagus, and some researchers believed that cola was effective because the carbon dioxide contained in it can wrap around the surface of the gastric stone and wash away the relatively loose parts, and the phosphoric acid contained in it can destroy the structure of the calcium-containing part of the stone. [6]
In any case, "cola therapy" has entered the field of vision of gastroenterologists, and has been used in the treatment of plant gastric stones such as improper consumption of hawthorn, persimmon and other foods (click to view previous tweets: Big stones appear in the stomach of the guy who binge ate hawthorn, doctor: go home and drink Coke BID), and the use method is not only the most basic oral treatment, but also endoscopic injection, continuous enteral infusion, etc.
A hospital reported a case of successful treatment of giant gastric stones by oral administration plus endoscopic injection of Coca-Cola. The 41-year-old diabetic patient presented with pain in his lower abdomen and vomiting after consuming persimmons 4 days prior to admission. Upper endoscopy revealed 3 large round stones in his stomach. On day 1 of treatment, this patient drank 2 cans of Coca-Cola every 6 hours. The next day, an endoscopy revealed that the stone partially dissolved and softened – drinking cola did work. [7]
Source: Source[7]
Subsequently, considering the patient's blood sugar problems, the doctor injected Coca-Cola directly into each stone through an endoscope and found that the stone was completely dissolved 1 day later.
However, "cola therapy" is not suitable for every patient with vegetative gastric stones: some studies have pointed out that patients with gastric stones are often complicated by gastroesophageal reflux, gastric bleeding and other diseases, and drinking large amounts of cola may lead to gastric perforation [8] . If you want to use "cola therapy", you need the guidance of a professional doctor.
Acknowledgments: This article was professionally reviewed by Tang Anliu, Deputy Chief Physician of the Department of Gastroenterology, Third Xiangya Hospital, Central South University
策划:sysoon|监制:carollero、gyouza
Title picture source: I took it myself
Source: Lilac Garden (O31)