Abstract
Calcium channel blockers have been previously shown to decrease lower esophageal sphincter (LES) pressure and improve symptoms in achalasia. We performed a placebocontrolled, double-blind, crossover study to assess the effects of oral nifedipine and verapamil on LES pressure, amplitude of esophageal body contraction, and clinical symptomatology in eight patients with symptomatic achalasia diagnosed by endoscopy, barium swallow, and manometry. Patients were randomized to receive up to 20 mg nifedipine, 160 mg verapamil, or placebo and underwent esophageal manometry before (baseline) and after four weeks on each drug. Diary cards were kept to record and grade symptoms and drug plasma level determinations were correlated with manometric and clinical findings. Both nifedipine and verapamil caused a statistically significant decrease in mean LES pressure, but only nifedipine caused a significant decrease in the amplitude of contractions of the smooth muscle portion of the esophagus. No statistically significant differences in the overall clinical symptomatology were noted with any of the drugs, although some individual improvements in dysphagia and chest pain were noted. We conclude that, despite the reduction in LES pressure and contraction amplitude of the distal esophageal body, oral nifedipine and verapamil do not significantly alter the clinical symptomatology of patients with achalasia.
Similar content being viewed by others
References
Cohen S: Motor disorders of esophagus. N Engl J Med 301:184–192, 1979
Vantrappen G, Janssens J: To dilate or to operate? That is the question. Gut 24:1013–1019, 1983 (editorial)
Vantrappen G, Hellemans J: Treatment of achalasia and related motor disorders. Gastroenterology 79:450–457, 1979
Schwartz ML, Rotmensch HH, Vlasses PH, Ferguson RK: Calcium blockers in smooth muscle disorders: Current status. Arch Intern Med 144:1425–1429, 1984
Becker BS, Burakoff R: The effect of verapamil on the lower esophageal sphincter pressure in normal subjects and in achalasia. Am J Gastroenterol 78:773–775, 1983
Blackwell JN, Holt S, Heading RC: Effect of nifedipine on oesophageal motility and gastric emptying. Digestion 21:50–56, 1981
Bortolotti M, Labo G: Clinical and manometric effects of nifedipine in patients with esophageal achalasia. Gastroenterology 80:39–44, 1981
Gelfond M, Rozen P, Gilat T: Isosorbite dinitrate and nifedipine treatment of achalasia: A clinical, manometric and radionuclide evaluation. Gastroenterology 83:963–969, 1982
Hongo M, Traube M, McAllister RG Jr, McCallum RW: Effects of nifedipine on esophageal motor function in humans: Correlation with plasma nifedipine concentration. Gastroenterology 85:8–12, 1984
Csendes A, Velasco N, Braghetto I, Henriquez A: A prospective randomized study comparing forceful dilation and esophagomyotomy in patients with achalasia of the esophagus. Gastroenterology 80:789–795, 1981
Ellis FH Jr, Gibb SP, Crozier RE: Esophagomyotomy for achalasia of the esophagus. Ann Surg 192:157–161, 1982
Traube M, McCallum RW: Calcium channel blockers and the gastrointestinal tract. Am J Gastroenterol 79:892–896, 1984
Berger K, McCallum RW: Nifedipine in the treatment of achalasia. Ann Intern Med 96:61–62, 1982
Thomas E, Lebow RA, Bubler RJ, Bryant LR: Nifedipine for the poor risk elderly patient with achalasia: Objective response demonstrated by solid meal study. South Med J 77:394–396, 1984
Traube M, Hongo M, Magyar L, McCallum RW: Effects of nifedipine in achalasia in patients with high amplitude peristaltic esophageal contractions. JAMA 252:1733–1736, 1984
Hongo M, Traube M, McCallum RW: Comparison of effects of nifedipine, propantheline bromide and the combination on esophageal motor function in normal volunteers. Dig Dis Sci 29:300–304, 1984
Richter JE, Dalton CB, Bradley LA, Castell DO: Oral nifedipine in the treatment of noncardiac chest pain in patients with the nutcracker esophagus. Gastroenterology 93:21–28, 1987
Traube M, Dubovik S, Lange RC, McCallum RW: The role of nifedipine therapy in achalasia: Results of a randomized, double-blind, placebo-controlled study. Am J Gastroenterol 84:1259–1262, 1989
Cohen S: Esophageal motility disorders and their responses to calcium channel antagonists. Gastroenterology 93:201–203, 1987 (editorial)
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Triadafilopoulos, G., Aaronson, M., Sackel, S. et al. Medical treatment of esophageal achalasia. Digest Dis Sci 36, 260–267 (1991). https://doi.org/10.1007/BF01318193
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01318193