A Dangerous Health Problem No One Talks About
The risk increases with age, but there are ways to prevent it
You’re sitting down to enjoy a nice steak at your favorite restaurant,
maybe sipping a little wine. Suddenly a piece of meat gets stuck in your
throat. It’s not enough to block your breathing, so you’re
not quite choking —but you also can’t get it down. You excuse
yourself and go to the restroom, hoping you can dislodge the food by either
coughing it up, inducing vomiting or drinking water.
Called “steakhouse syndrome,” this common scenario can lead
to death if you take matters into your own hands this way, says Dr. Robert
Glatter, emergency physician at Lenox Hill Hospital, N.Y., and assistant
professor at Hofstra Northwell School of Medicine.
“Anecdotally, a large number of people who suffer from steakhouse
syndrome, and who succumb to its dangerous complications, are found dead
in restaurant restrooms,” Glatter says. He notes that people often
feel self-conscious or embarrassed and fearful when they can’t get
their food down,and then excuse themselves to attempt to clear the blockage
on their own. “This is the biggest mistake, and it can cost you
your life,” he says.
“If you experience steakhouse syndrome, remain calm and let others
around you know the food is not going down. This is not a time to feel
self-conscious or embarrassed,” notes Glatter.
People who recurrently experience "food sticking," or who have
had steakhouse syndrome need to be evaluated by a gastroenterologist.
— Dr. Robert Glatter
By definition, steakhouse syndrome is a general term used to describe a
food impaction in the esophagus, says Dr. Hardeep Singh, gastroenterologist
with St. Joseph’s Hospital in Orange, Calif.
“It’s typically a big piece of meat or bread, and it usually
passes. But it presents a problem if it doesn’t pass — then
the person should get to the ER,” he says.
Causes and Risk Factors
The risk of getting food stuck in your esophagus increases with age, which
may be for several reasons, says Singh.
“It’s more common with increased body weight, which often occurs
as we get older, and acid reflux, the latter of which causes irritation
and a narrowing of the esophagus. In addition, the contractions of the
esophagus become less vigorous with age,” Singh says. A lowered
mucus production and some medications could predispose a person to acid
reflux (GERD), he adds.
People who experience steakhouse syndrome are often diagnosed later with
an abnormality called Schatzki’s ring, thickened tissue at the lower
end of the esophagus from GERD, says Glatter. This ring acts like a speed
bump in the esophagus. It also may be associated with inflammatory
conditions such as eosinophilic esophagitis, strictures or even cancer
of the esophagus.
Alcohol can be a factor, since you may not be paying as close attention
to the size of the piece of meat you’re eating or you may be eating
too fast if you’re under the influence, says Singh. The most common
problematic foods include dry turkey and well-done steak.
Prevention and Treatment
It’s important to take immediate action, since “waiting it
out” could cause a perforation of the esophagus, which is life threatening,
says Singh. “If you feel something stuck in your throat, try taking
small sips of water or drink a carbonated beverage, which can also help.
If that doesn’t work, go to the ER.”
People who recurrently experience “food sticking” or who have
had steakhouse syndrome need to be evaluated by a gastroenterologist,
says Glatter. “A gastroenterologist can perform an endoscopy [a
nonsurgical procedure used to examine a person’s digestive tract]
to evaluate for any conditions that can lead to obstruction of the lower
esophagus.” Glatter has firsthand experience with steakhouse syndrome,
having suffered from it himself.
In general, especially if you’re prone to this syndrome, preventive
measures include eating smaller pieces of meat and chewing slowly. Be
sure to chew your food completely, says Glatter, “and drink copious
amounts of water with your meal.”
If you notice someone else having difficulty, it’s imperative to
alert people and staff at restaurants to call 911. Do not attempt the
Heimlich maneuver, since that can lead to perforation if enough pressure
has built up in the esophagus, Glatter adds.
What Not to Do
The main risk of steakhouse syndrome is aspiration of the food into your
lungs, since people often try to induce vomiting to clear the obstruction.
“It’s dangerous to induce vomiting because this can lead to
perforation if enough pressure builds up in the lower esophagus,”
says Glatter. “And don’t try to gulp large amounts of water
in an attempt to clear the obstruction as this can increase pressure in
the esophagus and may also set you up for aspiration of contents to the
lungs if you start vomiting.”
Past treatments involved under-the-tongue nitroglycerin to relax the esophagus
to allow the food to pass, but that has been generally ineffective. Endoscopy
is now considered the treatment of choice, says Glatter.