Epidemiology
Foreign body ingestion and food impaction are common gastrointestinal (GI) problems. Fortunately, >80% of ingested foreign bodies pass through the GI tract without incident. However, sharp/pointed objects (e.g., razor blades, bones, pins, needles, wire, or nails) and objects >2.5 cm in diameter will not pass through the pyloric opening, and objects >6 cm long will not advance through the duodenal loop. High-powered magnets and batteries have also been implicated in complications and are difficult to remove.
Children aged <15 years account for 70% to 80% of patients with foreign bodies in the upper GI tract, with the highest incidence in children between 1 and 3 years old. In children with swallowed foreign bodies, there is no sex predominance. Metallic objects are more often found than non-metallic objects, with coins being the most common object removed from the upper GI tract of children in Western countries.[9][10] In a study carried out in Turkey, blue beads attached to a safety pin (a cultural good luck charm) (38.6%), coins (27.8%), and turban pins (18.1%) were the most common foreign body ingested. The blue beads/safety pins were found to be ingested primarily by infants, whereas ingestion of turban pins was mostly seen in adolescent girls who covered their heads.[11] One European retrospective study found that patients with foreign body ingestion seen annually increased from 66 in 2005 to 119 in 2017.[12] In Asian countries, fish bones are the most common foreign body removed from the upper GI tract of children.[13][14] In a retrospective study carried out in a teaching hospital in Kathmandu, Nepal, most common foreign bodies ingested by children were coins (64%), followed by meat bones (14%).[15]
An increasing number of cases of ingestion of button batteries and high-powered magnets in children have been reported, likely due to the increased use of these types of batteries in toys and household gadgets.[16][17][18] High-powered magnets can cause serious and potentially life-threatening complications, particularly if more than one is ingested, as the magnets can attract each other through the intestinal wall, causing bowel wall ischaemia and perforation.[3][19]
In adults, the incidence of accidentally or intentionally swallowing foreign bodies is higher in men than women. Food impaction is the most common cause of upper GI obstruction and is associated with: primary neurological disorders involving gag reflex impairment (e.g., Parkinson's disease, post-ictal states, post-stroke, dementia); use of alcohol/recreational drugs or other centrally acting medications that cause sedation; use of hypnotic or mental depressing agents (e.g., benzodiazepines, narcotics); and oesophageal disorders (e.g., eosinophilic oesophagitis, Schatzki's ring, and peptic strictures). Adults with non-food foreign bodies have a high incidence of psychiatric pathologies, chemical dependence, or social disturbances.
In 2019, 4923 deaths caused by suffocation following foreign body ingestion (ICD-11 codes PB06, PB07) were reported in the US.[20] Of these deaths, more than 70% (n=3625) occurred in people aged over 65 years.[20]
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