title: Use of Proteolytic Enzymes in the Treatment of Proteinaceous Esophageal Food Impaction.
abstract: BACKGROUND
  Proteinaceous esophageal food impaction typically requires endoscopic intervention. An alternative approach is the use of proteolytic enzymes. Concerns regarding the use of proteolytic enzymes include the risk of perforation and aspiration pneumonitis.
  
  
  OBJECTIVE
  We retrospectively reviewed our series of 69 patients treated with papain to determine the safety and efficacy of proteolytic enzymes.
  
  
  METHODS
  Patients were retrospectively reviewed if treated for an esophageal food impaction from 1999 through 2008.
  
  
  RESULTS
  Median age was 56 years (range 19-91 years), with 46 male and 23 female patients. In 27 patients (39%) this was their first presentation, in 14 (20%) it was the second, and 28 (41%) had multiple previous episodes. Meat was the cause in 49 (71%), chicken in 6 (9%), fish in 3 (4%), and unspecified in 11 (16%). All patients presented with dysphagia for solids, 56 (81%) could not tolerate liquids. Papain solution, 1 tsp in 8 oz of water, was given to patients in an unlimited quantity. Papain was successful in relieving the obstruction in 60 patients (87%). The remaining 9 patients (13%) underwent endoscopy with successful retrieval. No patient suffered a perforation, either with papain ingestion or endoscopy. There were no episodes of pneumonitis or pneumonia.
  
  
  CONCLUSIONS
  We have used proteolytic enzymes with a high success rate and with minimal complication. Further, if proteolytic enzymes fail, endoscopy can be performed safely and effectively. We recommend the use of proteolytic enzymes as the initial management in all patients with proteinaceous food impaction of the esophagus.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Morse
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Howard
authors.initials: H
authors.lastname: Wang
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Dean M
authors.initials: DM
authors.lastname: Donahue
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Garrity
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: James S
authors.initials: JS
authors.lastname: Allan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000188:drug therapy / Q000209:etiology; D004940:Esophageal Stenosis / Q000188:drug therapy*; D005260:Female; D005547:Foreign Bodies / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008460:Meat; D008875:Middle Aged; D010206:Papain / Q000627:therapeutic use*; D010447:Peptide Hydrolases / Q000627:therapeutic use*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D010447:Peptide Hydrolases; D010206:Papain
keywords: esophageal foreign body; food impaction; papain