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Abstracts: CLINICAL VIGNETTES/CASE REPORTS - ESOPHAGUS

Watch It Grow: Esophageal Impaction With Chia Seeds

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Rawl, Rebecca MD, MPH; Browne, Lauren MD

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American Journal of Gastroenterology: October 2014 - Volume 109 - Issue - p S244-S245
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Introduction: A 39-year-old male with asthma and seasonal allergies presented with the acute onset of persistent, severe dysphagia. The patient had a long history of intermittent dysphagia to solids which had worsened over the preceding 2 weeks. Twelve hours before presentation, he swallowed a tablespoon of dry chia seeds followed by a glass of water. He immediately experienced epigastric discomfort and was unable manage his oral secretions. Glucagon did not relieve his symptoms. Emergent EGD showed complete distal esophageal obstruction with a gel of hydrated chia seeds. Attempts at traversing or advancing the bolus using an adult diagnostic upper endoscope were unsuccessful. Removal of the seeds using a Roth net and grasping forceps was also unsuccessful due to a semi-solid consistency. A neonatal gastroscope was advanced past the obstruction revealing a stricture at the GE junction. The neonatal gastroscope was then used to push small amounts of the chia seed gel into the stomach until the impaction was relieved. The patient was started on twice daily PPI, and a liquid diet was recommended until repeat endoscopy was performed. Chia seeds (Salvia hispanica) are small (2mm x 1.5mm), oval seeds native to Mexico and Guatemala. They have been used for food, medicine, and paint since Aztec civilization. They were initially introduced to the U.S. by terracotta “pets” on which the seeds would grow. Over the last 5 years, their use as a food product has been growing in popularity due to high protein, omega-3 fatty acid, and fiber content. Chia seeds are marketed to improve cardiovascular health, promote weight loss, and improve glycemic control. When added to liquid, dry chia seeds immediately begin to form a hydrogel capsule absorbing up to 27 times their weight in water. In the stomach, this process contributes to a feeling of satiety. In our patient, an underlying esophageal stricture resulted in the formation of a hydrogel in his esophagus causing complete esophageal obstruction. This is the first report of esophageal food impaction with chia seeds. With the increasing popularity of chia seeds, patients with a history of dysphagia or esophageal strictures should be cautioned about their use, especially in their dry form.

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