Abstract
Background
Esophageal food impaction is a common illness presenting to emergency departments
(ED), and is frequently resistant to pharmacologic therapy. Several medications have
been promoted for this indication, but so far have not proven effective. Endoscopic
removal is frequently required to resolve the impaction, resulting in risks from anesthesia
and the physical procedure, and in prolonged hospital stay for recovery. Oral nitroglycerin
solution was recently used in two such cases and may represent a new therapeutic option.
Case Reports
A 49-year-old man presented to an ED with dysphagia 30 min after eating steak. He
was given 0.4 mg nitroglycerin dissolved in 10 mL tap water orally, and obtained complete
relief of symptoms within 2 min. A 43-year-old man with eosinophilic esophagitis and
two prior food impaction episodes presented to a community ED with dysphagia and epigastric
discomfort 110 min after eating steak. Five hours after symptom onset and after failure
of intravenous glucagon, he was given 0.4 mg nitroglycerin sublingually, which resulted
in headache but no relief in dysphagia. Twenty-nine minutes later he received 0.4 mg
nitroglycerin solution, as above, with symptom resolution within 2 min.
Why Should an Emergency Physician Be Aware of This?
The cases presented above demonstrate close temporal relationships between administration
of oral nitroglycerin solution and symptom relief. Oral nitroglycerin solution for
esophageal food impaction seemed effective in these cases, but further research on
this therapeutic option is warranted.
Keywords
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Article info
Publication history
Published online: March 05, 2018
Accepted:
January 19,
2018
Received:
January 16,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
