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Oral Nitroglycerin for Food Impaction

June 25, 2020

Written by Alex Chen, MD

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Oral nitroglycerin didn’t seem to be particularly effective for esophageal food impaction (EFI) in this small, non-blinded single arm study. Only 11.8%, or 2/17 patients, had relief of their symptoms after NTG administration.

Why does this matter?
People have tried all sorts of things to help with esophageal food impactions (soda, seltzer, glucagon, benzodiazepines) and none of them seems to work better than placebo. If you measure success by the amount of inbox messages that pharmacy will send you and getting vomit all over your shoes, this is peak success (I’m looking at you glucagon).

Silly intern, if only you used Coke instead of Sprite he would have been home by now!
This was a very small study (17 patients included) that was single-arm and non-blinded. Their success rate for resolution of EFI with oral NTG (0.4mg SL tablet dissolved in 10mL of water) was 11.8% or 2/17 patients. However, a whopping 47.1% of patients either developed an adverse event (headache, hypotension) or did not tolerate the oral dosing. I personally would just call GI for EGD and skip the hand-waving interventions that may cause harm with little chance of benefit.

Oral Nitroglycerin Solution for Oesophageal Food Impaction: A Prospective Single-Arm Pilot Study. Emerg Med J. 2020 May 3;emermed-2019-209320. doi: 10.1136/emermed-2019-209320. Online ahead of print.

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