Sublingual Nitroglycerine for Esophageal Meat Impaction

Abstract

Purpose: A 48 year old female presented to a community hospital emergency room with sudden onset of dysphagia to liquids and solids 3 hours after eating meat for supper. She denied heartburn, tobacco or alcohol use and had no previous problems with swallowing. She was not taking any medications and was unable to tolerate saliva. A trial of glucagon resulted in no improvement. The emergency room physician contacted the endoscopist on-call at the teaching hospital who suggested that she be given a trial of sublingual nitroglycerine 0.3 mg. This agent was suggested as it has been shown to cause a significant reduction in lower esophageal sphincter pressure in normal subjects as well as in patients with achalasia, Chagas' disease and esophageal spasm (1-4). Within 20 minutes after sublingual nitroglycerine adminstration, the patient passed the meat bolus spontaneously. She did develop mild transient hypotension from the nitroglycerine which responded to intravenous fluids. Follow-up elective endoscopy 2 months later revealed a Schatzki ring which was dilated with a 48 French Maloney dilator. Biopsies of the esophagus showed only mild non-secific inflammation, without evidence of eosinophilic esophagitis. Based on this experience, it appears that sublingual nitroglycerine may be helpful in emergency room management of esophageal meat impaction and may reduce the need for urgent endoscopy.