Digestive Diseases and Sciences

, Volume 29, Issue 7, pp 649–656 | Cite as

Effects of oral calcium blocker, diltiazem, on esophageal contractions

Studies in volunteers and patients with nutcracker esophagus
  • Joel E. Richter
  • Timothy J. Spurling
  • Carmel M. Cordova
  • Donald O. Castell
Original Articles


Animal studies have shown that calcium blocking drugs decrease lower esophageal sphincter pressure and inhibit peristaltic amplitude and duration. In a single-dose acute study, we compared the effects of a new oral calcium blocker, diltiazem (90, 120, 150 mg) with placebo in five volunteers and 10 patients with chest pain/dysphagia and high amplitude peristaltic contractions in the distal esophagus-nutcracker esophagus. In volunteers, diltiazem had no effect on esophageal contractions when compared to baseline values or placebo. In contrast, most doses of diltiazem significantly (<0.05) decreased amplitude and duration of peristaltic contractions in patients with nutcracker esophagus. Despite adequate blood levels, interstudy analysis was not statistically significant because placebo also decreased these parameters. During an eight-week open-labeled study, diltiazem 90 mg QID significantly (P<0.01) improved symptoms of chest pain and dysphagia. Side effects were minimal. Although oral diltiazem has minimal effect on baseline esophageal contractions our chronic study suggests it may modify transient increases in neuromuscular tone associated with esophageal chest pain. These observations warrant further placebo-controlled studies.


Placebo Chest Pain Diltiazem Lower Esophageal Sphincter Blocking Drug 
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.
    Stone PH, Antman EM, Muller JE, Braunwold E: Calcium channel blocking agents in the treatment of cardiovascular disorders. Ann Intern Med 93:886–904, 1980Google Scholar
  2. 2.
    Goyal RK, Rattan S: Effects of sodium nitroprusside and verapamil on lower esophageal sphincter. Am J Physiol 238:40–44, 1980.Google Scholar
  3. 3.
    Richter JE, Sinar DR, Cordova CM, Castell DO: Verapamil—a potent inhibitor of esophageal contractions in the baboon. Gastroenterology 82:882–886, 1982.Google Scholar
  4. 4.
    Richter JE, Sinar DR, Cordova CM, Castell DO: Calcium antagonists—potent inhibitors of esophageal function.In Motility of the Digestive Tract. M Wienbeck (ed.). New York, Raven Press, 1982, pp 557–564Google Scholar
  5. 5.
    Weiser HF, Lepsein G, Golenhofer K, Siewert R: Clinical and experimental studies on the effect of nifedipine on smooth muscle of the esophagus and LES.In Gastrointestinal Motility in Health and Disease. H. Duthie (ed) Lancaster, England, MTP Press, 1978, pp 565–572Google Scholar
  6. 6.
    Bortolotti M, Labo G: Clinical and manometric effects of nifedipine in patients with esophageal achalasia. Gastroenterology 80:39–44, 1981Google Scholar
  7. 7.
    Blackwell JN, Holt S, Heading HC: Effect of nifedipine on oesophageal motility and gastric emptying. Digestion 21:50–56, 1981Google Scholar
  8. 8.
    Berger K, McCallum RW: Nifedipine in the treatment of achalasia. Ann Inter Med 96:61–62, 1982Google Scholar
  9. 9.
    Benjamin SB, Gerhardt DC, Castell DO: High amplitude, peristaltic esophageal contractions associated with chest pain and/or dysphagia. Gastroenterology 77:478–483, 1979Google Scholar
  10. 10.
    Brand DL, Martin D, Pope CE II: Esophageal manometrics in patients with angina-like chest pain. Dig Dis Sci 22:300–304, 1977Google Scholar
  11. 11.
    Herrington JP, Burns TW, Balart LA: Dysphagia in patients with prolonged peristaltic contractile duration—a clinical and manometric analysis. Gastroenterology 80:1173A, 1981Google Scholar
  12. 12.
    Orr WC, Robinson WG: Hypertensive peristalsis in the pathogenesis of chest pain: Further exploration of the “nut-cracker” esophagus. Am J Gastroenterol 77:604–607, 1982Google Scholar
  13. 13.
    London RL, Onyang WJ, Snape WJ, Goldberg S Hirshfeld JW, Cohen S: Provocation of esophageal pain by ergonovine or edrophonium. Gastroenterology 81:10–14, 1981Google Scholar
  14. 14.
    Arndorfer R: Improved infusion system for intraluminal esophageal manometry. Gastroenterology 73:23–27, 1977Google Scholar
  15. 15.
    Osgood H: A peculiar form of oesophagismus. Boston Med Surg J 120:401–405, 1889Google Scholar
  16. 16.
    Nagler R, Spiro HM: Serial esophageal motility studies in asymptomatic young subjects. Gastroenterology 41:371–379, 1961Google Scholar
  17. 17.
    Meyer GW, Castell DO: Human esophageal response during chest pain induced by swallowing cold liquids. JAMA 246:2057–2060, 1981Google Scholar
  18. 18.
    Kikendoll JW, Mellow MH: Effect of sublingual nitroglycerin and long-acting nitrate preparation on esophageal motility. Gastroenterology 79:703–706, 1980Google Scholar
  19. 19.
    Gelfond M, Rozen P, Keren S, Gilat T: Effect of nitrates on LOS pressure in achalasia: A potent therapeutic aid. Gut 22:312–318, 1981Google Scholar
  20. 20.
    Orlando RC, Boyzmski EM: Clinical and manometric effects of nitroglycerine in diffuse esophageal spasm. N Engl J Med 289:23–25, 1973Google Scholar
  21. 21.
    Mellow MH: Effect of isosorbide and hydralazine in painful esophageal motility disorders. Gastroenterology 83:364–370, 1982Google Scholar
  22. 22.
    Obrecht WF, Richter JE, Kerr RM, Castell DO, Bradley RA, Young LD: Is the nutcracker esophagus past of the spectrum of irritable bowel syndrome? Gastroenterology 84:1262A, 1983Google Scholar
  23. 23.
    Benjamin SB, Richter JE, Cordova CM, Knuff TE, Castell DO: Prospective manometric evaluation with pharmacologic provocation of patients with suspected esophageal motility dysfunction. Gastroenterology 84:893–898, 1983Google Scholar
  24. 24.
    Silverstein BD, Kramer CM, Pope CE II: Treatment of esophageal motor disorders with a calcium-blocker, diltiazem. Gastroenterology 82:1181A, 1982Google Scholar
  25. 25.
    Zelis R: Calcium-blocker therapy for unstable angina pectoris. N Engl J Med 306:926–928, 1982Google Scholar

Copyright information

© Plenum Publishing Corporation 1984

Authors and Affiliations

  • Joel E. Richter
    • 1
    • 2
  • Timothy J. Spurling
    • 1
    • 2
  • Carmel M. Cordova
    • 1
    • 2
  • Donald O. Castell
    • 1
    • 2
  1. 1.Gastroenterology BranchNational Naval Medical CenterBethesda
  2. 2.Digestive Diseases Division, Department of MedicineUniformed Services University of the Health SciencesBethesda

Personalised recommendations