When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Last reviewed: 16 Mar 2025
Last updated: 14 Feb 2023

Summary

Definition

History and exam

Key diagnostic factors

  • dysphagia
  • nonspecific abdominal pain
  • stridor and wheezing
  • drooling

Other diagnostic factors

  • gagging, nausea/vomiting, neck/throat pain
  • atypical chest pain or noncardiac chest pain
  • choking
  • lower gastrointestinal bleeding
  • pain on swallowing
  • fever, poor feeding, failure to thrive, and irritability (in children)
  • acute or chronic asthma-like symptoms or recurrent pneumonia
  • signs of sepsis
  • sign of acute drug intoxication

Risk factors

  • age <15 years
  • male sex (adults)
  • gastrointestinal tract narrowing
  • chemical dependence
  • intellectual disability
  • mental illness
  • inmates or people engaged in criminal activities
  • dental disorders
  • hurried eating
  • impaired gag reflex
  • history of underlying esophageal disease, surgery, or procedure
  • seizure disorder

Diagnostic tests

1st tests to order

  • x-rays of neck, chest, abdomen
  • CBC
  • basic metabolic panel
  • prothrombin time (PT)/INR, PTT
  • handheld metal detector

Tests to consider

  • cardiac biomarkers and ECG
  • CT of neck, chest and/or abdomen
  • MRI
  • laryngoscopy
  • endoscopy

Treatment algorithm

Contributors

Authors

Brian M. Fung, MD

Gastroenterology Fellow

Division of Gastroenterology and Hepatology

Department of Internal Medicine

University of Arizona College of Medicine - Phoenix

Phoenix

AZ

Disclosures

BMF is the author of one reference cited in this topic.

Acknowledgements

Dr Brian M. Fung and Dr James H. Tabibian would like to gratefully acknowledge Dr Andrew C. Meltzer, Dr Juan Carlos Munoz, and Professor Luis F. Laos, previous contributors to this topic.

Disclosures

ACM, JCM, and LFL declare that they have no competing interests.

Peer reviewers

Prakash Adhikari, MBBS, MS

Consultant

Ganesh Man Singh Memorial Academy of ENT and Head and Neck Studies

TU Teaching Hospital

Maharajgunj

Kathmandu

Nepal

Disclosures

PA declares that he has no competing interests.

Jose Fernando Aycinena, MD

General Surgery Chief Resident

Department of General Surgery

University of Tennessee Medical Center

Knoxville

TN

Disclosures

JFA declares that he has no competing interests.

Richard V. Schaller, Jr, MD

Clinical Research Fellow

Cleveland Clinic Florida

Weston

FL

Disclosures

RVS declares that he has no competing interests.

David J. Hackam, MD, PhD

Associate Professor of Pediatric Surgery

University of Pittsburgh School of Medicine

Pittsburgh

PA

Disclosures

DJH declares that he has no competing interests.

Use of this content is subject to our disclaimer