RESUMO
OBJECTIVE: To determine the efficacy and safety of cola in resolving complete oesophageal food bolus impaction. DESIGN: Open label, multicentre, randomised controlled trial. SETTING: Emergency departments of five Dutch hospitals at the secondary and tertiary level, between 22 December 2019 and 16 June 2022. PARTICIPANTS: 51 adults presenting with complete oesophageal food bolus impaction, defined as a sudden inability to pass saliva after consumption of foods. Patients who ingested meat that contained bones, and patients with an American Society of Anesthesiologists (ASA) physical status classification of IV or higher were excluded. INTERVENTIONS: 28 patients in the intervention group were instructed to consume 25 mL cups of cola at intervals up to a maximum total volume of 200 mL. 23 patients in the control group awaited spontaneous passage. In either group, if complete resolution of symptoms did not occur, endoscopic removal was performed following current guidelines: within 6 hours for patients with complete obstruction, and within 24 hours for partial obstruction. In case of complete resolution of symptoms, elective diagnostic endoscopy was required. MAIN OUTCOME MEASURES: Improvement of oesophageal food bolus obstruction as reported by patients (ie, aggregate of complete and partial passage), and evaluation of complete passage. The secondary outcome was any intervention related adverse event. RESULTS: Cola did not have a meaningful effect on the improvement of food bolus obstruction (17/28 (61%) intervention v 14/23 (61%) control; odds ratio 1.00, 95% confidence interval 0.33 to 3.1; relative risk reduction 0.0, 95% confidence interval -0.55 to 0.36; P>0.99). Complete passage was reported more often in the intervention group but this difference was not significant (12/28 (43%) intervention v 8/23 (35%) control; odds ratio 1.4 (0.45 to 4.4); relative risk reduction -0.23 (-1.5 to 0.39); P=0.58). No severe adverse events occurred. However, six (21%) patients in the intervention group experienced temporary discomfort after drinking cola. CONCLUSIONS: In this study, cola consumption did not lead to a higher rate of improvement of complete oesophageal food bolus impaction. Given the lack of adverse events in the treatment group and some events of resolution after treatment, cola might be considered as a first line treatment, but should not delay any planning of endoscopic management. TRIAL REGISTRATION: Netherlands Trial Register (currently International Clinical Trial Registry Platform) NL8312.
Assuntos
Esôfago , Alimentos , Adulto , Humanos , Ingestão de Alimentos , Países BaixosRESUMO
Consult Online is a Dutch telemedicine system for physicians who work in international healthcare and tropical medicine (formerly known as 'tropical doctors'). It provides specialist advice for complicated cases where local specialist services are lacking. Eighty-nine experts from 25 different specialties are available for advice via www.troie.nl/consult-online. Most of these experts have worked in low resource settings for years before becoming specialists in other disciplines. Since its inception in 2008, Consult Online has received 639 consultations from 41 different countries. On average, a consultation resulted in 2.3 reactions. Consult Online is not the only telemedicine service for low resource settings, but it offers Dutch physicians the unique opportunity to liaise with specialists from their home country, who understand their background, training and limitations. A decade later, it continues to be available to anyone in need of tailor-made specialist advice for patients in low resource settings.
Assuntos
Consulta Remota/métodos , Telemedicina/métodos , Medicina Tropical , Humanos , Cooperação Internacional , Especialização , Medicina Tropical/métodos , Medicina Tropical/organização & administraçãoRESUMO
A 25-year-old Papuan presented with three painless foot ulcers with undermined edges, induration and oedema. The appearance was typical for Buruli ulcer, which is caused by Mycobacterium ulcerans. A smear was positive for acid fast bacilli. Buruli ulcers are found in patients from humid and tropical regions and are treated with rifampicin and streptomycin during eight weeks.
