Cola cure? Study sheds light on soda's potential for common holiday medical emergency

By Pooja Toshniwal PahariaReviewed by Danielle Ellis, B.Sc.Dec 14 2023

In a recent study published in BMJ, researchers performed a randomized controlled trial (RCT) to evaluate the safety and effectiveness of cola in relieving esophageal meal bolus impaction.

Background

The primary therapy for esophageal food impaction is emergent endoscopy, which is intrusive and costly. Studies have reported that cola relieved food impactions, minimizing the strain on emergency and endoscopic personnel.

Cola is inexpensive and widely accessible, and if proven effective, may reduce visits to the emergency department and emergent endoscopies by enabling patients to consume it in residential or primary care settings. However, several pharmacological therapies have yielded limited or contradictory results.

About the study

In the present multicenter, open-label RCT, researchers compared cola intake to the current standard of care for patients with food impactions in the esophagus, which does not include pre-endoscopic therapy while waiting for emergency endoscopic removal.

The researchers conducted the RCT in the emergency care departments of four secondary-level and one tertiary-level Dutch hospital between December 22, 2019, and June 16, 2022. The study included 51 individuals aged above 18 years presenting to emergency departments with complete esophageal food impaction, described as a feeling of food lodgement between oropharyngeal and epigastric tissues during swallowing with a sudden and complete saliva passage inability after consuming food.

Researchers excluded individuals with bone-containing meat, American Society of Anesthesiologists (ASA) status class ≥IV, conservative therapies (nitrates, glucagon, carbonated beverages, or nifedipine), visible food particles on oral inspection, or severe aspiration risk (Glasgow Coma Scale below 14 or prior relevant aspiration) from the study.

Emergency department registrars and physicians enrolled patients randomized 1:1 to the study groups. The team collected sociodemographic and health data from the emergency department through questionnaires, recording information on oesophageal food bolus obstructions, including food nature, impaction duration, previous obstructions, and known esophageal pathology.

In total, the treatment group participants (n=28) consumed cups of 25 mL Coca-Cola each minute (maximum volume, 200 mL in eight sips of 25 mL each). Control group individuals (n=23) awaited food passage without undergoing pre-endoscopic therapy. If symptoms were unresolved, endoscopic procedures were performed to remove the impacted food within six hours for complete esophageal obstruction and one day for partial esophageal obstruction, following current guidelines.

Complete symptomatic resolution cases required elective diagnostic endoscopies. The primary study outcome was a patient-reported improvement in esophageal food obstruction (i.e., partial and complete passage aggregate) and complete passage assessment. Secondary outcomes included treatment-related adverse events graded using the Adverse Events Gastrointestinal Endoscopy (AGREE) system.

Results

The median values for participant age in the treatment and control groups were 58 years and 54 years, respectively. The study included predominantly male participants. Most impactions resulted from meat, fries, bread, and sauerkraut consumption. Out of 41 individuals with meat impaction, 41% (nine out of 22) of treatment recipients and 37% (seven out of 19) of controls reported complete food passage. Of 10 individuals ingesting other food items, 50% (three out of six) of treatment recipients and 25% (one out of four) of controls reported complete food bolus passage.

Cola intake did not significantly improve food obstruction [17 out of 28 individuals (61%) in the treatment group vs. 14 out of 23 (61%) in the control group; odds ratio (OR), 1.0; relative risk (RR) reduction of 0.0]. Treatment recipients more often reported complete food passage; however, the difference was non-significant [12 out of 28 (43%) treatment recipients vs. 8 out of 23 (35%) controls; OR, 1.4; RR reduction of 0.2].

The study found that 18% of treatment recipients and 26% of controls completed partial food bolus passage within 40 and 45 minutes, respectively. However, 21% of treatment group participants experienced transient discomfort after cola consumption without requiring intervention or a prolonged duration of emergency department stay. Cola intake ranged from 25 mL to 125 mL, with a mean consumption of 50 mL. None of the adverse events required urgent or emergent endoscopic procedures, and two treatment group individuals and four controls developed mucosal lesions.

Twelve individuals had impacted food for less than an hour, with 63% of treatment recipients experiencing complete resolution. In the treatment group, 79% of 28 participants underwent elective, urgent, or emergent endoscopy, whereas 78% of 41 participants had esophageal pathology. OF 20 participants reporting complete resolution, ten did not undergo diagnostic endoscopy, and six were lost during follow-up. The team did not find significant differences between the study groups or in comparing individuals experiencing food passage to those who did not.

The study findings showed that cola intake did not significantly improve complete esophageal food bolus impaction. Current guidelines recommend follow-up in all instances of food bolus impaction and further investigation into the benefit of cola in early or partial oesophageal impactions.