[Physiopathology and therapy of foreign bodies in the upper digestive tract]

Fibroendoscopy is the treatment of choice for foreign oesophageal and gastric bodies. Whereas the presence of objects in the oesophagus demands immediate endoscopic removal, gastric localization does not require any emergency treatment except for cases of perforation or incarceration, as most foreign bodies (80-90%) are eliminated naturally. Only two weeks after ingestion, in the case of failed expulsion, is it necessary to proceed to endoscopic removal so as to prevent decubitus or perforation erosions. Endoscopic extraction is made difficult by the length and weight of the object, on by its smallness and lack of texture, which make it hard to get hold of. In the case of suture stitches, it may be hard to cut them because of the presence of a gastric mucosa reactive granulomatous inflammatory process. Contraindications to endoscopic extraction are the failure of the patient to cooperate, acute oesophagitis (peptic and due to caustics) and perforating in the stomach, due to congenital or acquired malformations, means that surgery is necessary. The elimination of foreign bodies depends on the correlation between shape and size of object and the anatomo-functional components of the digestive ways. With reference to an approximate geometric schematization of transit organs, the physiopathology of foreign bodies may be expressed by means of mathematical formulae whose manifold variables sometimes make the natural elimination of the bodies unpredictable.