Oral nitroglycerin an effective treatment for esophageal food impaction

A study published in The Journal of Emergency Medicine describes the use of oral nitroglycerin solution in 2 patients presented to emergency department with esophageal food impaction.

The study was conducted by Benjamin A. Willenbring, Regions Hospital, St. Paul, MN, and colleagues to determine the therapeutic relevance of oral nitroglycerin for esophageal food impaction.

The effectiveness of glucagon, often used for the treatment of esophageal food impaction is found to be inconsistent based on several studies. Oftentimes, endoscopic removal is required to resolve an impaction that poses patients at an increased risk for complications associated with anesthesia or the procedure itself, as well as a longer hospitalization for recovery. Based on the 2 cases, the authors believe oral nitroglycerin solution may serve as a potential therapeutic option for resolving esophageal food impaction.

In the first case, a 49-year-old male presented to the emergency department with dysphagia 30 minutes after eating steak. He received oral nitroglycerin solution (nitroglycerin 0.4mg sublingual tablet dissolved in 10mL of tap water) and subsequently experienced complete resolution of impaction sensation within 2 minutes.

In a separate case, a 43-year-old male with eosinophilic esophagitis presented to the emergency department with dysphagia and epigastric discomfort 110 minutes after having a meal consisting of steak and potatoes. The patient reported 2 previous episodes of esophageal food impaction, one successfully treated with intravenous (IV) glucagon, the other requiring endoscopic treatment. During this visit, he was administered IV glucagon which did not relieve his symptoms, and then oral nitroglycerin, accidentally given sublingually. The sublingual nitroglycerin provided no relief of his epigastric symptoms but did cause a headache. Twenty-nine minutes later he was given a nitroglycerin solution similar to the one noted in the first case which led to complete resolution of symptoms within 2 minutes.

"Oral nitroglycerin solution for esophageal food impaction seemed effective in these cases, but further research on this therapeutic option is warranted," concluded Dr. Willenbrig.

For further information click on the link: https://doi.org/10.1016/j.jemermed.2018.01.024