Oral Nitroglycerin Solution: An Effective Option for Esophageal Food Impaction?

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A report published in The Journal of Emergency Medicine describes the use of oral nitroglycerin solution in 2 cases of esophageal food impaction which is often seen in patient taking food withut adequate water and chewing it properly or taking hard spicky food with less saliva or motility disorders of oesophagus or having cardiospasm or malignancy.

 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.

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