The American Journal of Digestive Diseases

, Volume 20, Issue 8, pp 703–707 | Cite as

The adverse effect of chocolate on lower esophageal sphincter pressure

  • Lewis E. Wright
  • Donald O. Castell
Original Articles


Decreased lower esophageal sphincter (LES) pressure after ingestion of chocolate has been previously noted. We have further evaluated the effect of chocolate on the known ability of gastric alkalinization or bethanechol to increase LES tone. 9 normal subjects were studied using an infused open-tip recording system. Pressure was monitored for a 15-min basal period, and for 60 min after ingestion of 120 ml of chocolate syrup either alone or with the concurrent administration of commercial antacid, oral bethanechol, or subcutaneous bethanechol. After chocolate ingestion, mean basal LES pressure of 14.6±1.1 (±SEM) mm Hg decreased significantly (P<0.01) to 7.9±1.3 mm Hg. An identical LES response occurred when antacid was given with the chocolate dose. Oral bethanechol (25 mg) and chocolate together resulted in lesser decreases in LES pressure. Subcutaneous bethanechol (5 mg) and chocolate produced significant increases (P<0.05) in sphincter pressure, although of lesser magnitude than reported with bethanechol alone. These results indicate that the adverse effect of chocolate on the LES is not reversed by gastric alkalinization and suggest that bethanechol in sufficient dose may overcome chocolate-induced decreases in LES pressure.


Public Health Adverse Effect Recording System Lower Esophageal Sphincter Basal Period 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Babka JC, Castell DO: On the genesis of heartburn. The effects of specific foods on the lower esophageal sphincter. Am J Dig Dis 18:391–397, 1973PubMedGoogle Scholar
  2. 2.
    Castell DO, Levine SM: Lower esophageal sphincter response to gastric alkalinization. Ann Intern Med 74:223–227, 1971PubMedGoogle Scholar
  3. 3.
    Farrell RL, Castell DO, McGuigan JE: Measurements and comparisons of lower esophageal sphincter pressures and serum gastrin levels in patients with gastroesophageal reflux. Gastroenterology 67:415–422, 1974PubMedGoogle Scholar
  4. 4.
    Higgs RH, Smith RD, Castell DO: Gastric alkalinization: Effect on lower esophageal sphincter pressure and serum gastrin. N Engl J Med 291:486–490, 1974PubMedGoogle Scholar
  5. 5.
    Roling GT, Farrell RL, Castell DO: Cholinergic response of the lower esophageal sphincter. Am J Physiol 222:967–972, 1972PubMedGoogle Scholar
  6. 6.
    Farrell RL, Roling GT, Castell DO: Stimulation of the incompetent lower esophageal sphincter: A possible advance in therapy of heartburn. Am J Dig Dis 18:646–650, 1973PubMedGoogle Scholar
  7. 7.
    Goyal RK, Rattan S: Mechanism of the lower esophageal sphincter relaxation. J Clin Invest 52:337–341, 1973PubMedGoogle Scholar
  8. 8.
    Nebel OT, Castell DO: Inhibition of the lower esophageal sphincter by fat—A mechanism for fatty food intolerance. Gut 14:270–274, 1973PubMedGoogle Scholar
  9. 9.
    Nebel OT, Castell DO: Lower esophageal sphincter pressure changes after food digestion. Gastroenterology 63:778–783, 1972PubMedGoogle Scholar
  10. 10.
    Nebel OT, Castell DO: Kinetics of fat inhibition of the lower esophageal sphincter. J Appl Physiol 35:6–8, 1973PubMedGoogle Scholar
  11. 11.
    Farrell RL, Roling GT, Castell DO: Cholinergic therapy of chronic heartburn. A controlled trial. Ann Intern Med 80:573–576, 1974PubMedGoogle Scholar

Copyright information

© Digestive Disease Systems, Inc. 1975

Authors and Affiliations

  • Lewis E. Wright
    • 1
  • Donald O. Castell
    • 1
  1. 1.The Gastroenterology Branch, Internal Medicine Service And Clinical Investigation ServiceU.S. Naval HospitalPhiladelphia

Personalised recommendations