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by Chwistek M

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.
The Esophagus
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Causes

Steakhouse syndrome is caused by a mass of food, usually meat, blocking the passageway of the esophagus.

Risk Factors

Factors that may increase your chance of steakhouse syndrome 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:
    • Ring of tissue that forms in the lower part of the esophagus—Schatzkis ring
    • Narrowing of the esophagus caused by scar tissue—esophageal stricture
    • Upper part of the stomach moves up through a small opening into the chest—hiatal hernia
    • Chronic inflammation in the esophagus—eosinophilic esophagitis
    • Esophageal cancer or other tumors

Symptoms

Steakhouse syndrome may cause:
  • Chest pain
  • Difficulty swallowing
  • Drooling
  • Coughing, gagging, choking

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done.
Imaging tests to evaluate the esophagus may include:

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 or you are not able to swallow your saliva, the doctor may need to remove it from your esophagus. An endoscope can locate the bolus. Once the bolus has been found, tiny surgical instruments 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 steakhouse syndrome:
  • Chew slowly and until the food is small enough to safely swallow.
  • If you have been diagnosed with a condition that affects your esophagus, follow your treatment plan.

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, et al. 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, 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/cse/cse0602.htm. Accessed September 29, 2014.
Stadler J, Hölscher AH, et al. The "steakhouse syndrome." Primary and definitive diagnosis and therapy. Surg Endosc. 1989;3(4):195-198.

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