An innovative fast track solution for food bolus impaction due to Jackhammer esophagus in an emergency department: the “Nitro-Push Blind Technique” case report

Abstract

BackgroundIn the medical literature are described only few clinical cases of esophageal food bolus impaction due to esophageal motility disorders. Moreover, the management of this condition is highly variable with no evidence in the literature to strongly support a clear defined intervention.Case presentationIn this paper we describe for the first time a case of 53-year-old male with food bolus impaction due to Jackhammer esophagus referred to emergency department. On the basis of the known esophageal past medical history as well as the absence of bones in the bolus, the patient was submitted to a new conservative treatment, the “Nitro-Push Blind Technique”.ConclusionsThe new technique performed with naso-gastric tube thrust after nitrates medication in definite clinical case supported by known functional disease, represents a safe and successful method, with short observational period to minimize exposure to potential morbidity and reduce the inpatient stay in emergency department. It should be recommended, once validated in a larger cohort, as the initial treatment of choice in the selected patients with food boneless bolus impaction in the emergency settings. Indeed, this management provides only minimal deviation from the current practice and is hence technically easy to learn and perform.

The evolution of treatment and complications of esophageal food impaction

“…2,3,5,6 There are multiple treatment methods for esophageal food impaction, including ingestion of carbonated beverages, medications that affect esophageal motility (glucagon and nitrates most commonly), and endoscopic or surgical removal of the food bolus. [7][8][9][10][11][12] Spontaneous resolution has been reported in up to 25% of food impaction patients. Medications have been effective in nearly 40% and endoscopy in more than 95% of patients.…”

Cola therapy for oesophageal food bolus impactions a case series

“…A variety of non-endoscopic medications and interventions are described in the current medical literature; however, all of these alternatives are associated with limited or conflicting studies on their use [4] , [5] . Examples include: butyl scopolamine [6] , [7] , glucagon [8] , [9] , benzodiazepines [10] , calcium channel blockers [11] , nitrates [12] , [13] , meat tenderizers (which has been firmly discredited and the only treatment known to cause harm) [14] , and effervescent drinks (e.g. cola) [15] .…”