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Medical treatment of esophageal motility disorders

Abstract

Swallowing is a complex mechanism that is based on the coordinated interplay of tongue, pharynx, and esophagus. Disturbances of this interplay or disorders of one or several of these components lead to dysphagia, non-cardiac chest pain, or regurgitation. The major esophageal motility disorders include achalasia, diffuse esophageal spasm, hypercontractile esophagus (“nutcracker esophagus”), and hypocontractile esophagus (“scleroderma esophagus”). Other esophageal diseases such as hypopharyngeal (Zenker's) diverticula or gastroesophageal reflux disease also may be sequelae of primary esophageal motility disorder. Finally, a substantial group of patients referred for evaluation of possible esophageal motor disorders have milder degrees of dysmotility—referred to as nonspecific esophageal motor disorder—that are of unclear clinical significance. Medical treatment of esophageal motility disorders involves the uses of agents that either reduce (anticholinergic agents, nitrates, calcium antagonists) or enhance (prokinetic agents) esophageal contractility. Despite the beneficial effect of the various drugs on esophageal motility parameters, the clinical benefit of medical treatment is often disappointing. From clinical and epidemiological studies there is some evidence for a “psychological” component in the pathogenesis or perception of esophageal symptoms. Further understanding of esophageal pathophysiology, as well as development of new receptor selective drugs, might increase our chances of successful treatment of esophageal motility disorders.

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References

  1. 1.

    Farrell RL, Roling G, Castell DO: Stimulation of the incompetent lower esophageal sphincter.Am J Dig Dis 18:646, 1973

  2. 2.

    McCallum RW, Kline MM, Curry N: Comparative effects of metoclopramide and bethanechol on lower esophageal sphincter pressure in reflux patients.Gastroenterology 68:1114–1118, 1975

  3. 3.

    Farrell RL, Roling GT, Castell DO: Cholinergic therapy of chronic heartburn: a controlled trial.Ann Int Med 80:573–576, 1974

  4. 4.

    Paterson WG, Selucky M, Hynna-Liepert TT: Effect of intraesophageal location and muscarinic blockade on balloon distention induced pain.Dig Dis Sci 36:282–288, 1991

  5. 5.

    Blackwell JN, Dalton CB, Castell DO: Oral pirenzepine does not affect esophageal pressure in man.Dig Dis Sci 31:230–235, 1986

  6. 6.

    Hassan M, Dalton CB, Castell JA, Castell DO: Pirenzepine and propatheline effects on esophageal pressure response to bethanechol.Am J Gastroenterol 81:334–338, 1986

  7. 7.

    Marzio L, Pieramico O, Neri M, Delle Donne M, Dimitri A, Imbimbo BP, Cuccurullo F: Comparative study of the effect of cimetropium bromide and atropine on human esophageal motor functions.Digestion 44:117–123, 1989

  8. 8.

    Lyrenäs E, Abrahamsson H: Beta adrenergic influence on oesophageal peristalsis in man.Gut 27:260–266, 1986

  9. 9.

    Katsuki S, Arnold W, Mittal C, Murad F: Stimulation of guanylase cyclase by sodium nitroprusside, nitroglycerin, and nitric oxide in various tissue preparations and comparison to the effects of Na azide and hydroxylamine.J Cyclic Nucleotide Res 3:23–35, 1977

  10. 10.

    Dodds WJ, Stewart ET, Kishk SM, Kahrilas PJ, Hogan WJ: Radiologic amyl nitrite test for distinguishing pseudoachalasia from idiopathic achalasia.AJR 146:21–23, 1986

  11. 11.

    Tottrup A, Svane D, Forman A: Nitric oxide mediating NANC inhibition in opossum lower esophageal sphincter.Am J Physiol 260:G385-G389, 1991

  12. 12.

    Tottrup A, Knudsen M, Gregersen H: The obligatory role of nitric oxide synthesis for lower esophageal sphincter relaxation (Abstract).Gastroenterology 100:A501, 1991

  13. 13.

    Gelford M, Rozen P, Gilat T: Isosorbit dinitrate and nifedipine treatment of achalasia: a clinical, manometric and radionuclide evaluation.Gastroenterology 83:963–969, 1982

  14. 14.

    Orlando RC, Bozymski EM: Clinical and manometric effects of nitroglycerin in diffuse esophageal spasm.N Engl J Med 289:23–25, 1973

  15. 15.

    Kikendall JW, Mellow MH: Effect of sublingual nitroglycerin and long acting nitrate preparation on esophageal motility.Gastroenterology 79:703–706, 1980

  16. 16.

    Mellow MH: Effect of Isosorbide and hydralazine in painful primary esophageal motility disorders.Gastroenterology 83:364–370, 1982

  17. 17.

    Weiser HF, Lepsien G, Golenhofen K, Schattenmann G, Siewert R: Klinische und experimentelle Untersuchungen zur Wirkung von Nifedipine auf die glatte Muskulator des Ösophagus.Z Gastroenterol 15:691–698, 1977

  18. 18.

    Blackwell JN, Holt S, Heading RC: Effect of nifedipine on oesophageal motility and gastric emptying.Digestion 21:50–56, 1981

  19. 19.

    Bortolotti M, Labo G: Clinical and mamometric effects of nifedipine in patients with esophageal achalasia.Gastroenterology 80:39–44, 1981

  20. 20.

    Nasrallah SM: Nifedipine in the treatment of esophageal spasm.Lancet 2:1285, 1985

  21. 21.

    Berger K, McCallum RW: Nifedipine in the treatment of achalasia.Ann Int Med 96:61–62, 1982

  22. 22.

    Traube M, Hongo M, Magyar L, McCallum RW: Effects of nifedipine in achalasia and in patients with high amplitude peristaltic esophageal contractions.J Am Med Ass 252:1733–1736, 1984

  23. 23.

    Becker BS, Burkoff R: The effect of verapamil on the lower esophageal sphincter pressure in normal subjects and in achalasia.Am J Gastroenterol 78:773–775, 1983

  24. 24.

    Konrad-Dahlhoff I, Baunack AR, Rämch K-D, Ahr G, Kraft H, Schmitz H, Weihrauch TR, Kuhlmann J: Effect of the calcium antagonists nifedipine, nitrendipine, nimodipine and nisodipine on lower esophageal sphincter pressure and contraction amplitudes after wet swallows. In: Kuhlmann J, Wingender W (eds.):Dose-Response Relationship of Drugs. München: W. Zuckerschwerdt Verlag, 1990, pp 144–148

  25. 25.

    Goyal RK, Rattan S, Hersh T: Comparison of the effects of prostaglandins E1, E2 and A2, and of hypovolemic hypotension on the lower esophageal sphincter.Gastroenterology 65:608–612, 1973

  26. 26.

    Mukhopadhyay A, Rattan S, Goyal RK: Effect of prostaglandin E2 on esophageal motility in man.J Appl Physiol 39:479–481, 1975

  27. 27.

    Maher JW, Hollenbeck JI, Crandall V: Prostaglandin E2 effect on lower esophageal sphincter pressure and serum gastrin.J Surg Res 24:87–91, 1978

  28. 28.

    Dilawari JB, Newman A, Poleo J: Response of the human cardiac sphincter to circulating prostaglandines F2 and E2 and to antiinflammatory drugs.Gut 16:137–143, 1975

  29. 29.

    Schwartz GJ, Levine RA, Petokas S, Gallo-Torres HE, Scheinbaum ML, Sondheimer JM: Effects of acute administration of a prostaglandine E2 analog, trimoprostil, on esophageal motility in man.Am J Gastroenterol 82:836–839, 1987

  30. 30.

    Schulze-Delrieu K: Metoclopramide.Gastroenterology 77:768–779, 1979

  31. 31.

    Weihrauch TR, Förster CF, Krieglstein J: Evaluation of the effect of domperidone on human oesophageal and gastroduodenal motility by intraluminal manometry.Postgrad Med J 55 (Suppl 1):7–10, 1979

  32. 32.

    Champion MC: Minireview domperidone.Gen Pharmacol 19:499–505, 1988

  33. 33.

    McCallum RW, Prakash C, Campoli-Richards DM, Goa KL: Cisapride. A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use as prokinetic agent in gastrointestinal motility disorders.Drugs 36:652–681, 1988

  34. 34.

    Hellenbrecht D: Pharmakologie von Prokinetika. In: Hotz J (ed.):Motilitätsstörungen im oberen Gastrointestinaltrakt. Berlin: Springer Verlag, 1990, pp 1–26

  35. 35.

    Albibi R, McCallum RW: Metoclopramide: pharmacology and clinical application.Ann Int Med 98:86–95, 1983

  36. 36.

    Koelz HR: Treatment of reflux esophagitis with H2-blockers, antacids and prokinetic drugs.Scan J Gastroenterol (Suppl 156) 24:25–36, 1989

  37. 37.

    Buchheit KH, Bertholet A: Analysis of the stimulatory effect of some bezamides in small intestinal motility.Naunyn Schmiedeberg's Arch Pharmacol 341 (Suppl):R88, 1990

  38. 38.

    Clarke DE, Craig DA, Fozzard JR: The 5-HT4 receptor: naughty but nice.Trends Pharmacol Sci 10:385–386, 1989

  39. 39.

    Gilbert RJ, Dodds WJ, Kahrilas PJ, Hogan WJ, Lipman S: Effect of cisapride, a new prokinetic agent, on esophageal motor function.Dig Dis Sci 32:1331–1336, 1987

  40. 40.

    Wallin L, Kruse-Ändersen S, Madsen T, Boesby S: Effect of cisapride on the gastro-oesophageal function in normal human subjects.Digestion 37:160–165, 1987

  41. 41.

    Corazziari E, Bontempo I, Anzini F: Effects of cisapride on distal esophageal motility in humans.Dig Dis Sci 34:1600–1605, 1989

  42. 42.

    Janisch HD, Hüttermann W, Bouzo MH: Cisapride versus ranitidine in the treatment of reflux esophagitis.Hepatogastroenterol 35:125–127, 1988

  43. 43.

    Horowitz M, Maddox A, Wishart J, Collins PJ, Sherman DJC: The effect of cisapride on gastric and esophageal emptying in 10 patients with dystrophia myotonica.J Gastroenterol Hepatol 2:285–293, 1987

  44. 44.

    Horowitz M, Maddern GJ, Maddox A, Wishart J, Chatterton BE, Sherman DJC: Effect of cisapride on gastric and esophageal emptying in progressive systemic sclerosis.Gastroenterology 93:311–315, 1987

  45. 45.

    Wehrmann T, Caspary WF: Einfluß von Cisaprid auf die Ösophagusmotilität bei Gesunden und Patienten mit progressiver systemischer Sklerodermie.Klin Wochenschr 68:602–607, 1990

  46. 46.

    Horowitz M, Maddox A, Harding PE, Maddern GJ, Chatterton BE, Wishart J, Sherman DJC: Effect of cisapride on gastric and esophageal emptying in insulin-dependent diabetes mellitus.Gastroenterology 92:1899–1907, 1987

  47. 47.

    Richter JE, Obrecht WF, Bradley LA, Young LD, Anderson KO: Psychological comparison of patients with nutcracker esophagus and irritable bowel syndrome.Dig Dis Sci 31:131–138, 1986

  48. 48.

    Clouse RE, Lustman PJ, Eckert TC, Ferney DM, Griffith LS: Low dose trazodone for symptomatic patients with esophageal contraction abnormalities: a double-blind placebo-controlled trial.Gastroenterology 92:1027–1036, 1987

  49. 49.

    Weihrauch T, Forster C, Kohler H, Ewe K, Krieglstein J; Effect of intravenous diazepam on human lower esophageal sphincter pressure under controlled double-blind crossover conditions.Gut 20:64–67, 1979

  50. 50.

    Reveille RM, Goff JS, Hollstrom-Tarwater K: The effect of intravenous diazepam on esophageal motility in normal subjects.Dig Dis Sci 36:1046–1049, 1991

  51. 51.

    Kaada B: Successful treatment of esophageal dysmotility and Raynaud's phenomenon in systemic sclerosis and achalasia by transcutaneous nerve stimulation.Scan J Gastroenterol 22:1137–1146, 1987

  52. 52.

    Guelrud M, Rossiter A, Souney PF, Sulbaran M: Transcutaneous electrical nerve stimulation decreases lower esophageal sphincter pressure in patients with achalasia.Dig Dis Sci 36:1029–1033, 1991

  53. 53.

    Traube M, Dubovik S, Lange RC, McCallum RW: The role of nifedipine in achalasia: results of a randomized, double-blind, placebo-controlled study.Am J Gastroenterol 84:1259–1262, 1989

  54. 54.

    Triadafilopoulos G, Aaronson M, Sackel S, Burakoff R: Medical treatment of esophageal achalasia—double-blind crossover study with oral nifedipine, verapamil, and placebo.Dig Dis Sci 36:260–267, 1991

  55. 55.

    Cohen S: Esophageal motility disorders and their response to calcium channel antagonists.Gastroenterology 93:201–203, 1987

  56. 56.

    Davies HA, Lewis MJ, Rhodes J, Henderson AH: Trial of nifedipine for prevention of esophageal spasm.Digestion 36:81–83, 1987

  57. 57.

    Richter JE, Spurling TJ, Cordova CM, Castell DO: Effects of oral calcium channels blocker, diltiazem, on esophageal contractions. Studies in volunteers and patients with nutcracker esophagus.Dig Dis Sci 29:649–656, 1984

  58. 58.

    Richter JE, Dalton CB, Bradley LA, Castell DO: Oral nifedipine in the treatment of noncardiac chest pain in patients with nutcracker esophagus.Gastroenterology 93:21–28, 1987

  59. 59.

    Winters C, Artnak EJ, Benjamin SB, Castell DO: Esophageal bougienage in symptomatic patients with nutcracker esophagus.JAMA 252:363–363, 1984

  60. 60.

    Katz PO, Geisinger KR, Hasan M, Wu WC, Huang D, Castell DO: Acid-induced esophagitis in cats is prevented by sucralfate but not by synthetic prostaglandin E.Dig Dis Sci 33:217–224, 1988

  61. 61.

    Ehrenpreis ED: Alkali esophagitis and sucralfate.Am J Gastroenterol 83:1187, 1988

  62. 62.

    Orr WC, Robinson MG, Humphries TJ, Antonello J, Cagliola A: Dose-response effect of famotodine on patterns of gastroesophageal reflux.Aliment Pharmacol Ther 2:229–236, 1988

  63. 63.

    Baldi F, Farrarini F, Longanesi A, Angeloni M, Ragazzini M, Miglioli M, Barbara L: Oesophageal function before, during and after healing of erosive esophagitis.Gut 29:157–160, 1988

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Correspondence to Dr. H. -D. Allescher MD.

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Allescher, H.-., Ravich, W.J. Medical treatment of esophageal motility disorders. Dysphagia 8, 125–134 (1993). https://doi.org/10.1007/BF02266993

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Key words

  • Dysphagia
  • Esophageal pharmacology
  • Cholinergic
  • Prokinetics
  • Calcium antagonists
  • Achalasia
  • Diffuse esophageal spasm
  • Gastroesophageal reflux
  • Deglutition
  • Deglutition disorders