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.
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.
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- Management of ingested foreign bodies and food impactions.Gastrointest Endosc. 2011; 73: 1085-1091
- Review of food bolus management.Can J Gastroenterol. 2008; 22: 805-808
- Treatment of acute esophageal food impaction with glucagon, an effervescent agent, and water.AJR Am J Roentgenol. 1994; 162: 325-328
- Safety and efficacy of glucagon for the relief of acute esophageal food impaction.Am J Health Syst Pharm. 2012; 69: 573-577
- Esophageal food impaction.Emerg Med News. 2001; : 12-14
- Etiology and management of esophageal food impaction: a population based study.Scand J Gastroenterol. 2015; 50: 513-518
- [Esophageal foreign bodies: analysis of 188 cases].Ulus Travma Acil Cerrahi Derg. 2009; 15 ([in Turkish]): 222-227
- [Analysis for 171 cases of esophageal foreign bodies impacted in upper esophagus with endoscopic treatment].Beijing Da Xue Xue Bao Yi Xue Ban. 2014; 46 ([in Chinese]): 160-164
- Esophageal food impaction: epidemiology and therapy. A retrospective, observational study.Gastrointest Endosc. 2001; 53: 193-198
- Outcomes of acute esophageal food impaction: success of the push technique.Gastrointest Endosc. 2001; 53: 178-181
- Myth: glucagon is an effective first-line therapy for esophageal foreign body impaction.CJEM. 2015; 11: 169-171
- Glucagon for the relief of esophageal food impaction does it really work?.Dig Dis Sci. 2006; 51: 1930-1933
- Effect of spasmolytic drugs on esophageal foreign bodies.Dysphagia. 1995; 10: 126-127
- The effect of glucagon and the combined effect of glucagon and secretin on lower esophageal sphincter pressure in man.Scand J Gastroenterol. 1974; 9: 615-618
- Nature and kinetics of inhibition of lower esophageal sphincter pressure by glucagon.Gastroenterology. 1974; 67: 42-46
- Effect of gastrointestinal hormone infusions of lower oesophageal competence of rhesus monkeys.Br J Surg. 1978; 65: 499-504
- Mitochondrial aldehyde dehydrogenase mediates vasodilator responses of glyceryl trinitrate and sodium nitrite in the pulmonary vascular bed of the rat.Am J Physiol Heart Circ Physiol. 2010; 299: H819-H826
Published online: March 05, 2018
Accepted: January 19, 2018
Received: January 16, 2018
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