Effect of cimetropium bromide on esophageal motility and transit in patients affected by primary achalasia

Abstract

The effect of cimetropium bromide, a new anticholinergic agent, in patients with primary achalasia was studied. Twenty such patients (12 females and 8 males, mean age 38 years, range 15–56) were studied. Diagnosis was performed by radiology, endoscopy, and manometry. Lower esophageal sphincter pressure and body wave amplitude were measured by means of a five-channel catheter constantly perfused by a low-compliance pneumohydraulic pump. Patient received cimetropium bromide 10 mg intravenously over 3 min or placebo in a double-blind manner. In five patients esophageal transit evaluated by scintiscanning was studied on separate occasions after cimetropium bromide or placebo. Baseline mean lower esophageal sphincter pressure was 46±5 mm Hg and mean amplitude of body waves was 30±8 mm Hg. Cimetropium bromide induced a significant decrease in sphincter pressure and body wave amplitude that measured 13±3 mm Hg and 8±4 mm Hg, respectively, 15 min after the end of infusion. The decrease was maintained for 45±5 min. A marked reduction in repetitive body waves was also noted. Esophageal transit was also accelerated with cimetropium bromide. Maximal stomach radioactivity was observed after 8±1.8 sec while with placebo this was reached after 65±1.5 sec (P<0.01). It is concluded that cimetropium bromide reduces LES pressure and shortens transit in primary esophageal achalasia. It may be useful in the treatment of this esophageal motility disorder.