Esophageal Food Impaction

Study Overview
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Brief Summary
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This study is designed to obtain data on the safety and efficacy of oral nitroglycerin solution for the treatment of esophageal food impaction in patients presenting to the Emergency Department with presumed esophageal food impaction. The main hypothesis is to determine the success rate of oral nitroglycerin solution in relieving the food impaction by assessing the resolution of symptoms and the ability of the patient to swallow.

Detailed Description
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A piece of food stuck in the esophagus (the tube connecting the mouth to the stomach) is a relatively common occurrence, estimated at a rate of 13 episodes per 100,000 people per year, mostly men, and usually attributed to swallowed meat. The current standard of care for patients presenting to an Emergency Department with this problem includes a trial of medication, usually glucagon but sometimes a carbonated beverage, an injection of nitroglycerin, or benzodiazepines. The medical interventions mentioned above have not been shown to be significantly effective and have unwanted side effects; glucagon is known to cause nausea and vomiting and benzodiazepines can cause sedation and depressed breathing. If the medication fails to relieve the problem, the patient may require a procedure called endoscopy, where a video scope and retrieval tool are inserted into the esophagus to remove the piece of food. There is significant risk associated with endoscopy, including the risks of anesthesia as well as with the physical procedure itself. Endoscopy also results in a prolonged hospital stay due to the time required for the procedure, as well as from anesthesia recovery. The ideal treatment would be a safe, inexpensive, quickly effective medication without significant side effects that could be administered without sedation or extensive monitoring. Oral nitroglycerin solution might just be that intervention.

Official Title
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Efficacy and Safety of Oral Nitroglycerin on Esophageal Food Impaction

Conditions
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Esophageal Food Bolus Obstruction

Intervention / Treatment
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* Drug: Nitrostat 0.4Mg Sublingual Tablet


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Over the age of 18 years Presentation consistent with esophageal food impaction Ability to swallow a small volume of liquid. Exclusion Criteria: Intractable vomiting Hemodynamic instability or SBP <100 mmHg Concern for or evidence of significant airway compromise Concern for or evidence of esophageal perforation, Concern for or evidence of coronary ischemia Presentation > 12 hours since onset.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Oral nitroglycerin solution<br>Up to 3 administrations of 0.4mg sublingual nitroglycerin tablets, dissolved in 10mL tap water, given orally in a single swallow. Each administration is separated by at least 5 minutes | Drug: Nitrostat 0.4Mg Sublingual Tablet<br>* Up to 3 administrations of 0.4mg sublingual nitroglycerin tablets, dissolved in 10mL tap water, given orally in a single swallow. Each administration is separated by at least 5 minutes, and only if systolic blood pressure > 100 mmHg.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patients Condition at Discharge | the proportion of study patients who achieve resolution of food impaction | Length of Emergency Department stay (Time Frame: up to 12 hours)] | 
| Medications/Procedures Performed During Visit | Total number of other medications or procedures used to relieve the esophageal food impaction | Length of Emergency Department stay (Time Frame: up to 12 hours)] |