Papain May Be Safe for Treating Proteinaceous Esophageal Food Impaction in the ED

Patients presenting with incomplete esophageal obstruction owing to proteinaceous food bolus need urgent endoscopy. While papain, an unripe papaya-derived proteolytic enzyme, was historically used to relieve food bolus impactions, its use was curtailed after case reports in the 1950s and 1960s noted the potential for esophageal perforation. More recent reports also raised concerns about aspiration pneumonitis and hemorrhagic pulmonary edema, and current recommendations from multiple societies specifically preclude its use.

Thoracic surgeons reviewed records for emergency department patients with esophageal obstruction owing to proteinaceous food obstruction who were initially treated with papain at a single academic medical center from 1999 …