Effects of nifedipine in achalasia and in patients with high-amplitude peristaltic esophageal contractions
M. Traube, M. Hongo, L. Magyar and R. W. McCallum
We studied the esophageal effects of nifedipine in 20 patients with
achalasia (20 mg sublingually) and nine patients with high-amplitude
peristaltic esophageal contractions (nutcracker esophagus) (20 mg orally).
In patients with achalasia, nifedipine decreased lower esophageal sphincter
(LES) pressure by approximately 30%. In ten patients with achalasia, plasma
nifedipine concentrations were 45.3 +/- 17.7 and 57.4 +/- 12.8 ng/mL (means
+/- SEM) at 30 and 60 minutes, respectively, after drug administration. In
patients with nutcracker esophagus, nifedipine decreased LES pressure by
approximately 50% and contraction amplitude in the body of the esophagus by
approximately 25%. After comparison was made with our previous results in
normal subjects, we concluded that (1) nifedipine decreased LES pressure in
patients with achalasia to a similar extent to that noted in normal
subjects; (2) plasma concentrations measured after 20 mg of nifedipine
given sublingually to achalasic patients were similar to those found under
similar circumstances in normal subjects; and (3) nifedipine decreased LES
pressure and contraction amplitude in patients with nutcracker esophagus to
a greater extent than was found in normal subjects. These results suggest
that double-blind, placebo-controlled clinical trials of nifedipine in the
treatment of achalasia or nutcracker esophagus are indicated.
