Festive Dysphagia: Eid-ul-Adha–Associated Food Bolus Obstruction and the Need for Public Awareness
Vol. 31, Special Issue 1 (July 2026)
Nazish Butt, MBBS, FCPS
Head of Gastroenterology Department
Jinnah Postgraduate Medical Centre
Chair WGO Endoscopy Committee
Karachi, Pakistan
Meritorious Professor Amanullah Abbasi, MBBS, FCPS, MRCPI, FRCPO
Chairperson, Medicine
Dow University of Health Sciences
Karachi, Pakistan
Sabir Ali, MBBS, FCPS
Consultant Gastroenterologist
Department of Gastroenterology
Jinnah Postgraduate Medical Centre
Karachi, Pakistan
Kanwal Butani, MBBS, FCPS
Consultant Gastroenterologist
Lyari General Hospital
Karachi, Pakistan
Introduction
Festive dysphagia is a descriptive term for the seasonal rise in cases of food bolus obstruction observed during Eid-ul-Adha. This Islamic festival involves the ritual sacrifice of livestock and widespread consumption of beef and mutton among families and communities. While the celebration symbolizes sacrifice, generosity, and unity, it is also associated with an increase in emergency presentations related to esophageal meat impaction.
Unlike chronic dysphagia, which is usually associated with neurological, structural, or motility disorders, festive dysphagia is predominantly triggered by behavioral factors such as hurried eating, inadequate mastication, distraction during meals, and swallowing large pieces of meat. Emergency departments in Pakistan, such as the Department of Gastroenterology at Jinnah Postgraduate Medical Centre (JPMC), Civil Hospital (Dow University Hospital), and Lyari General Hospital in Karachi, often experience a surge in patient volume during Eid. This pattern highlights the connection between cultural practices and acute gastrointestinal emergencies.
Epidemiology and Risk Factors
Food bolus obstruction can occur across all age groups but is most commonly observed in adults aged 18–50 years.1 In younger adults, underlying structural abnormalities such as Schatzki rings, eosinophilic esophagitis, or peptic strictures are frequently implicated. Elderly individuals over 60 years are at higher risk because of poor dentition, impaired chewing efficiency, decreased esophageal motility, and associated neurological diseases. Children are less commonly affected, although accidental ingestion of bone fragments or inadequately chewed meat may occasionally cause obstruction.
Several risk factors predispose individuals to festive dysphagia, including esophageal strictures, Schatzki rings, eosinophilic esophagitis, gastroesophageal reflux disease, stroke, Parkinson’s disease, poor dentition, rapid eating habits, and inadequate chewing of meat.
Clinical Presentation
Patients typically present with sudden-onset dysphagia immediately after meat ingestion, including sensation of food stuck in the throat or chest, inability to swallow saliva, drooling, retrosternal chest discomfort, anxiety and restlessness, recurrent vomiting, choking or coughing, or, in severe cases, respiratory distress.2
Complete esophageal obstruction with inability to handle secretions constitutes a medical emergency requiring urgent intervention.
Diagnosis
The diagnosis of festive dysphagia is primarily clinical and based on a detailed dietary history along with symptom onset following meat consumption. Upper gastrointestinal endoscopy confirms the diagnosis, identifies the location of obstruction, and enables simultaneous therapeutic intervention.
Plain radiographs may identify radiopaque foreign bodies such as bones but are often normal in soft meat impactions. Computed tomography is reserved for suspected perforation, aspiration, or mediastinal complications.
Because eosinophilic esophagitis is increasingly recognized as an important underlying cause of recurrent food impaction, esophageal biopsies should be considered during endoscopy whenever clinically indicated.3
Management
Endoscopic intervention remains the gold standard for the management of food bolus obstruction. Early endoscopy provides both therapeutic relief and diagnostic evaluation of underlying pathology.
Patients with complete obstruction, drooling, or inability to swallow saliva require emergent endoscopy, preferably within 2–6 hours. Stable patients with partial obstruction should undergo urgent endoscopy within 24 hours to prevent complications.4, 5
Retrieval Techniques
Retrieval devices such as rat-tooth forceps, alligator forceps, polypectomy snares, and Roth Net baskets are used to safely grasp and extract impacted meat boluses.
Push Technique
In selected patients with soft meat impaction, the bolus may be gently advanced into the stomach using the endoscope tip or overtube. This method should be avoided in cases involving sharp bone fragments or suspected strictures.
Fragmentation
Large boluses may be fragmented into smaller pieces to facilitate safe extraction.
Treatment of Underlying Pathology
Endoscopy also permits simultaneous dilation of esophageal strictures and biopsy of suspicious lesions or of eosinophilic esophagitis, thereby reducing the risk of recurrence.
Success rates of endoscopic management exceed 95% when performed promptly by experienced gastroenterologists. Pharmacological therapies such as glucagon or effervescent drinks have shown limited benefit and should not delay definitive intervention.
Surgical management is rarely required and is reserved for failed endoscopic retrieval or perforation.
Complications
Delayed diagnosis or prolonged obstruction may result in serious complications, including aspiration pneumonia, esophageal ulceration, mucosal ischemia, esophageal perforation, mediastinitis, and airway compromise.6, 7 Prompt intervention significantly reduces morbidity and mortality.
Clinical experience at JPMC, Dow University Hospital, and Lyari General Hospital reflects the seasonal burden of festive dysphagia during Eid-ul-Adha.
The following are a few illustrative cases that were presented during Eid:
A 45-year-old male arrived with acute dysphagia after consuming meat. An endoscopic examination revealed a large meat bolus lodged in the distal esophagus, which was successfully removed using a gentle push technique (Figures 1–3).
Figure 1. A large meat bolus lodged in the middle of the esophagus.
Figure 2. A large piece of meat and bone was carefully introduced into the stomach and subsequently extracted using a Roth Net basket.
Figure 3. A meat and bone bolus were extracted using a Roth Net basket.
A 62-year-old female, with a known history of benign peptic esophageal stricture, experienced an obstruction after quickly eating chunks of meat. Endoscopic removal, followed by dilation of the stricture, effectively alleviated her symptoms.
A 30-year-old female presented with severe chest discomfort and difficulty swallowing after ingesting bone fragments. Endoscopy revealed mucosal injury, which required careful extraction and the application of a hemoclip at the site of a minor perforation (Figures 4 and 5).
Figure 4. The impacted bone above the gastroesophageal junction has been removed using alligator forceps.
Figure 5. Small perforation with ulcer above GEJ due to impacted sharp bone.
These cases highlight the importance of rapid endoscopic access and multidisciplinary coordination during Eid-ul-Adha.
Prevention and Public Awareness
Festive dysphagia is largely preventable. Public health campaigns before Eid-ul-Adha should focus on safe eating practices and early recognition of warning symptoms.
Preventive recommendations include eating slowly and mindfully, chewing meat thoroughly, avoiding swallowing large chunks of meat, carefully removing bone fragments, and avoiding talking or laughing while swallowing. Seek immediate medical care if food becomes stuck.
Mosques, community gatherings, television programs, and social media campaigns can serve as effective platforms for awareness dissemination.
Hospitals should also prepare for increased caseloads during Eid by ensuring availability of emergency endoscopy services, anaesthesia support, trained staff, and multidisciplinary coordination between gastroenterologists, surgeons, and emergency physicians.
Summary
Festive dysphagia is a significant yet preventable gastrointestinal emergency that arises during the Eid-ulAdha celebrations. While most cases can be effectively managed through endoscopy, a delay in treatment can lead to serious complications. Raising public awareness, promoting mindful eating habits, ensuring rapid access to emergency endoscopy, and enhancing hospital preparedness are essential measures that can substantially reduce the burden of this condition while preserving the spirit and joy of the festival. As the saying goes, “Prevention is better than cure.”
References
- Chilukuri P, Odufalu F, Hachem C. Dysphagia. Mo Med. 2018;115(3):206–210.
- Leopard D, Fishpool S, Winter S. Management of oesophageal soft food bolus obstruction: A systematic review. Ann R Coll Surg Engl. 2011;93(6):441–444.
- Dellon ES, Gonsalves N, Hirano I, et al. ACG Clinical Guideline: Evidenced-based approach to the diagnosis and management of eosinophilic esophagitis. Am J Gastroenterol. 2013;108(5):679–692.
- European Society of Gastrointestinal Endoscopy (ESGE). Guideline for removal of foreign bodies in the upper gastrointestinal tract. Endoscopy. 2016;48:489–496.
- Longstreth GF, et al. Esophageal food impaction: Epidemiology and management. Gastroenterol Clin North Am. 1991;20(4):691–701.
- Triadafilopoulos G. Esophageal food bolus impaction: Epidemiology, diagnosis, and management. UpToDate. 2025.
- ASGE Standards of Practice Committee. Management of ingested foreign bodies and food impactions. Gastrointest Endosc. 2021;93(5):1085–1091.
