Friday, February 13, 2015

Lung hemorrhage, pulmonary edema, and alveolitis

Among adults, pills constitute 7% of all foreign-body aspiration. A symptom triad of cough, wheezing, and decreased air entry should alert clinicians to suspect aspiration. The presence of the foreign object in the airway may lead to airway obstruction, atelectasis, granulation tissue formation, postobstructive pneumonia, and bronchiectasis. All aspirated foreign bodies require immediate attention.

Sucralfate is an oral cytoprotective agent used to treat and prevent gastroduodenal ulcers. Sucralfate demonstrates a high affinity for erosive mucosa, due to its viscous adhesiveness and formation of polyvalent bridges. It also buffers acid, inhibits the action of pepsin, and absorbs bile salts. Furthermore, sucralfate binds to uninjured mucosa and acts as a barrier on regenerated and normal mucosa. Aspiration of sucralfate has been reported to cause acute hypoxemia from complete occlusion of a lobar bronchus.
Lung hemorrhage
Lung hemorrhage

The sucralfate tablet can rapidly expand when in contact with bronchial mucosa. A large, moist, sucralfate tablet can completely occlude a bronchus, causing acute respiratory failure. In animal models, sucralfate suspension has also been shown to cause lung hemorrhage, pulmonary edema, and alveolitis. In patients at risk for aspiration, the use of sucralfate granules instead of its tablet form is recommended.

Capsule endoscopy is a widely accepted imaging modality with a good diagnostic yield and good safety profile. The most common complication is capsule retention, reported in about 1% to 2% of procedures. Capsule aspiration in the airways is rarer yet and is a potentially fatal complication in the presence of chronic lung diseases. This condition commonly occurs in elderly patients with or without prior history of swallowing disorders. 

It may result in hypoxemic respiratory failure, obstructive pneumonitis, and bronchial injury during its removal. In elderly patients who have difficulty swallowing, the capsule might need to be placed in the duodenum endoscopically to prevent its aspiration. Regardless, the aspirated endoscopic capsule should be retrieved immediately.

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