ABSTRACT
BACKGROUND: Esophagogastric junction outflow obstruction (EGJOO) is a heterogenous disorder in which the correct management strategy is unclear. We assessed whether functional lumen imaging probe (FLIP) topography data could select EGJOO, which would benefit from lower esophageal sphincter Botulinum toxin (Botox) injection. METHODS: This was a single-center prospective study of adult patients meeting Chicago Classification (CC) v3.0 criteria for EGJOO. We assessed differences in pretreatment physiologic measurements on high-resolution manometry (HRM) and FLIP and other relevant clinical variables in predicting Botox response (>50% in BEDQ at 2 months). KEY RESULTS: Sixty-nine patients were included (ages 33-90, 73.9% female). Of these, 42 (61%) were Botox responders. Majority of physiologic measures on HRM and FLIP and esophageal emptying were not different based on Botox response. However, a spastic-reactive (SR) FLIP contractile response (CR) pattern predicted a Botox response with OR 25.6 (CI 2.9-229.6) when compared to antegrade FLIP CR; and OR for impaired-disordered/absent CR was 22.5 (CI 2.5-206.7). Logistic regression model using backward elimination (p value = 0.0001, AUC 0.79) showed that a SRCR or IDCR/absent response and the upright IRP predicted Botox response. Response rates in tiered diagnostic groups were: (i) CCv3.0 EGJOO (60.9%), (ii) CCv4.0 EGJOO (73.1%), (iii) CCv4.0 + FLIP REO (80%), (iv) CCv4.0, FLIP REO, and abnormal FLIP CR (84.2%), and (v) CCv4.0, FLIP REO, and SR FLIP CR (90%). CONCLUSIONS AND INFERENCES: FLIP helps identify patients with EGJOO who are likely to response to LES Botox therapy. An abnormal FLIP contractile response pattern is the single-most important predictor of a Botox response.
Subject(s)
Botulinum Toxins, Type A , Esophageal Motility Disorders , Esophagogastric Junction , Manometry , Humans , Female , Middle Aged , Male , Aged , Adult , Esophagogastric Junction/physiopathology , Esophagogastric Junction/drug effects , Manometry/methods , Esophageal Motility Disorders/drug therapy , Esophageal Motility Disorders/physiopathology , Prospective Studies , Botulinum Toxins, Type A/pharmacology , Botulinum Toxins, Type A/therapeutic use , Aged, 80 and over , Muscle Contraction/drug effects , Neuromuscular Agents/pharmacology , Neuromuscular Agents/therapeutic use , Treatment OutcomeABSTRACT
Patients with esophageal dysphagia need a step-by-step approach for diagnosis and treatment. Endoscopic with biopsy and barium esophagogram are the essential tests evaluating anatomical abnormality and esophageal bolus stasis. Further imaging or esophageal function tests such as high-resolution esophageal manometry, functional endoluminal imaging probe, CT or endoscopic ultrasound are required. In the case of dysphagia due to esophageal motility disorder, whether it is the major motility disorder or minor motility disorder should be identified in high resolution manometry. Major motility disorders show esophagogastric junction obstruction or major peristaltic defects. In this case, the severity of the symptoms should be assessed and patients who need endoscopic or surgical treatment targeting lower esophageal sphincter should be screened. Impaired lower esophageal sphincter relaxation (achalasia, esophagogastric junction outflow obstruction, esophageal spasm or abnormal hypercontraction (jackhammer esophagus), hypotensive contraction (ineffective esophageal motility, failed peristalsis), esophageal hypersensitivity (noncardiac chest pain), gastroesophageal reflux disease and esophageal bolus stasis are the possible mechanisms causing dysphagia symptoms. The proper medical treatment depends on underlying mechanisms.
Subject(s)
Deglutition Disorders , Deglutition Disorders/etiology , Esophageal Motility Disorders/diagnosis , Esophageal Motility Disorders/drug therapy , Humans , ManometrySubject(s)
Esophageal Motility Disorders/diagnosis , Heartburn/physiopathology , Manometry/methods , Patient Positioning , Benzamides/therapeutic use , Esophageal Motility Disorders/drug therapy , Esophageal Motility Disorders/physiopathology , Esophageal pH Monitoring , Female , Gastrointestinal Agents/therapeutic use , Humans , Middle Aged , Morpholines/therapeutic use , Sitting Position , Supine PositionABSTRACT
BACKGROUND: Esophageal hypercontractility (EHC) is considered a major esophageal motor disorder of unclear etiology. Different mechanisms have been proposed, including an imbalance in inhibitory and excitatory esophageal innervation. We hypothesized that patients with EHC suffer from cholinergic hyperactivity. AIM: To interrogate the excitatory and inhibitory neurotransmission in EHC by assessing the esophageal motor response to atropine (ATR) and cholecystokinin (CCK), respectively, in EHC patients. METHOD: We retrospectively reviewed patients who underwent high-resolution manometry (HRM) with pharmacologic challenge in a tertiary referral center between 2007 and 2017. We identified 49 EHC patients who were categorized based on frequency of hypercontractile peristaltic sequence into "frequent" and "infrequent" and motility diagnosis groups. Deglutitive pressure metrics and esophageal motor responses to ATR (12 mcg/kg iv) and CCK (40 ng/kg iv) were analyzed across groups. RESULTS: Atropine abolished hypercontractility across all groups studied, converting nearly half of patients to a motor pattern of ineffective esophageal motility. Abnormal CCK responses primarily occurred in the patient groups with concomitant outflow obstruction. CONCLUSIONS: Hypercontractility is cholinergically mediated in all esophageal motor disorders. Most patients with isolated EHC appear to have excessive cholinergic drive, rather than loss of inhibitory innervation, and might be candidates for treatment with anticholinergic agents.
Subject(s)
Atropine/administration & dosage , Esophageal Motility Disorders/drug therapy , Esophagus/drug effects , Muscarinic Antagonists/administration & dosage , Peristalsis/drug effects , Aged , Atropine/therapeutic use , Esophageal Motility Disorders/physiopathology , Esophagus/physiopathology , Female , Humans , Male , Manometry , Middle Aged , Muscarinic Antagonists/therapeutic use , Muscle Contraction/drug effects , Retrospective StudiesSubject(s)
Esophageal Motility Disorders/etiology , Esophageal Mucosa/pathology , Esophageal Stenosis/diagnosis , Gastroesophageal Reflux/diagnosis , Proton Pump Inhibitors/administration & dosage , Biopsy , Diagnosis, Differential , Diverticulosis, Esophageal/diagnosis , Esophageal Motility Disorders/diagnosis , Esophageal Motility Disorders/drug therapy , Esophageal Motility Disorders/pathology , Esophageal Mucosa/diagnostic imaging , Esophageal Stenosis/drug therapy , Esophageal Stenosis/etiology , Esophageal Stenosis/pathology , Esophagoscopy , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/drug therapy , Gastroesophageal Reflux/pathology , Humans , Male , Middle AgedABSTRACT
We experienced marked efficacy with steroid treatment of three patients with jackhammer esophagus (JHE). An esophageal biopsy revealed eosinophilic esophagitis (EoE) in two patients. One of the patients without EoE had eosinophilia and an increased serum immunoglobulin E level, and endoscopic ultrasonography revealed thickening of the esophageal muscularis propria. Esophageal manometry was used to diagnose all cases of JHE. Treatment consisted of steroid administration, which improved the symptoms and resolved the esophageal muscularis propria thickening in all patients. The esophageal manometry findings also normalized following treatment. Allergic diseases, including EoE, were assumed to have caused JHE.
Subject(s)
Esophageal Motility Disorders/drug therapy , Adult , Biopsy , Endosonography , Eosinophilic Esophagitis/complications , Esophageal Motility Disorders/complications , Female , Humans , Immunoglobulin E/blood , Male , Manometry , Middle Aged , Treatment OutcomeABSTRACT
Ineffective esophageal motility is the most frequent esophageal motility disorder. It is currently defined by 50% or more ineffective esophageal contractions and a normal lower esophageal sphincter relaxation on high-resolution esophageal manometry. Although reported in patients without symptoms, it is typically associated with gastro-esophageal reflux disease, and might be a consequence of the reflux. Ineffective esophageal motility can account for a certain degree of dysphagia, and is associated with a more severe gastroesophageal reflux. Todate, no specific endoscopic or pharmacologic treatment is available, and proton pump inhibitor are advisable when gastro-esophageal reflux is associated.
Subject(s)
Esophageal Motility Disorders/etiology , Gastroesophageal Reflux/complications , Asymptomatic Diseases , Deglutition Disorders/etiology , Eosinophilic Esophagitis/complications , Esophageal Motility Disorders/drug therapy , Gastroesophageal Reflux/drug therapy , Humans , Proton Pump Inhibitors/therapeutic use , Scleroderma, Systemic/complications , SyndromeABSTRACT
With the advances in technology and medical knowledge, new diseases are being identified and investigated. Esophageal motility disorders have been re-defined using high-resolution manometry and their pathogenesis are being better understood. The use of opioid analgesics is increasing worldwide, particularly in the United States, but their chronic use can cause opioid-induced esophageal dysfunction, which mimics spastic motor disorders, including achalasia type 3 or 2 and esophagogastric junction outflow obstruction. Eosinophilic esophagitis is identified by eosinophilic infiltration confirmed on a pathological examination. The condition is often associated with esophageal motility abnormalities. On the other hand, recent studies have suggested that muscle-predominant eosinophilic infiltration, eosinophilic esophageal myositis, might manifest as spastic motor disorders, including achalasia or jackhammer esophagus. Lymphocytic esophagitis is an unusual esophageal condition, which is confirmed by the increased number of lymphocytes in the esophageal epithelium. Although several reports have supported the existence of lymphocytic esophagitis, it is still unclear whether lymphocytic esophagitis is a distinct disease entity or another spectrum of other esophageal diseases, such as gastroesophageal reflux disease or eosinophilic esophagitis. This review presents evidence and reports on the emerging issues in esophageal motility disorders, including opioid-induced esophageal dysfunction, eosinophilic esophagitis with eosinophilic esophageal myositis, and lymphocytic esophagitis.
Subject(s)
Esophageal Motility Disorders/diagnosis , Analgesics, Opioid/adverse effects , Eosinophilic Esophagitis/diagnosis , Eosinophilic Esophagitis/drug therapy , Eosinophilic Esophagitis/etiology , Esophageal Motility Disorders/drug therapy , Esophageal Motility Disorders/etiology , Glucocorticoids/therapeutic use , Humans , Lymphocytes/cytology , Lymphocytes/immunology , Lymphocytes/metabolism , Proton Pump Inhibitors/therapeutic useABSTRACT
INTRODUCTION: Botulinum toxin injection is known to be efficient to treat achalasia. We conducted a randomized trial in order to evaluate its efficacy to treat symptomatic hypercontractile esophageal disorders as characterized by esophageal high-resolution manometry. METHODS: Patients with significant dysphagia and/or thoracic pain related to an hypercontractile esophageal motility disorder as defined by the Chicago Classification were randomized to receive an injection of botulinum toxin (100 U in 10 points in the distal part of the esophageal wall) or a sham procedure. Symptoms were assessed at 3 months with the Eckardt score. Patients could receive a first or second botulinum toxin injection 1 month later if symptoms persisted. RESULTS: Twenty-three patients (13 women, mean age 60 years) were included: 13 received botulinum toxin injection, and 10 a sham procedure. The improvement of symptoms at 3 months was significant compared to baseline, but similar in the active treatment and sham procedure arms. However, there was no change in quality of life scores. Seventeen patients received a second injection at 4 months. There was a significant trend toward improvement of symptoms up to the end of follow-up at 12 months, without a significant relationship with the administration of botulinum toxin. DISCUSSION: Botulinum toxin injection is not superior to a sham procedure to improve symptoms related to hypercontractile esophageal disorders, suggesting an important placebo effect in for this type of disease. This observation must be taken into account when evaluating more aggressive therapies such as endoscopic myotomy (clinicaltrials.gov: NCT01955174).
Subject(s)
Botulinum Toxins, Type A/therapeutic use , Esophageal Motility Disorders/drug therapy , Neuromuscular Agents/therapeutic use , Adult , Aged , Double-Blind Method , Female , Humans , Male , Middle AgedSubject(s)
Esophageal Motility Disorders/diagnosis , Esophageal Motility Disorders/physiopathology , Esophagus/physiopathology , Gastrointestinal Motility , Rumination, Digestive , Adult , Animals , Bethanechol/administration & dosage , Deglutition , Esophageal Motility Disorders/drug therapy , Female , Humans , Manometry , Muscarinic Agonists/administration & dosage , Severity of Illness Index , Syndrome , Treatment OutcomeABSTRACT
This trial was designed to assess the prevalence and characteristics of Jackhammer esophagus (JE), a novel hypercontractile disorder associated with progression to achalasia and limited outcomes following anti-reflux surgery in patients with typical symptoms of GERD and responsiveness to proton pump inhibitor (PPI) therapy. Consecutive patients, who were referred for surgical therapy because of PPI responsive typical symptoms of GERD, were prospectively assessed between January 2014 and May 2017. Patients diagnosed with JE subsequently underwent rigorous clinical screening including esophagogastroduodenoscopy (EGD), ambulatory pH impedance monitoring off PPI and a PPI trial. Out of 2443 evaluated patients, 37 (1.5%) subjects with a median age of 56.3 (51.6; 65) years were diagnosed with JE and left for final analysis. Extensive testing resulted in 16 (43.2%) GERD positive patients and 5 (13.9%) participants were observed to have an acid hypersensitive esophagus. There were no clinical parameters that differentiated phenotypes of JE. The prevalence of JE in patients with typical symptoms of GERD and response to PPI therapy is low. True GERD was diagnosed in less than half of this selected cohort, indicating the need for objective testing to stratify phenotypes of JE. (NCT03347903).
Subject(s)
Esophageal Motility Disorders/drug therapy , Esophageal Motility Disorders/etiology , Proton Pump Inhibitors/therapeutic use , Aged , Endoscopy, Digestive System , Esomeprazole/therapeutic use , Esophageal Motility Disorders/diagnosis , Esophageal Motility Disorders/epidemiology , Esophageal pH Monitoring , Female , Gastroesophageal Reflux/drug therapy , Gastroesophageal Reflux/etiology , Humans , Male , Manometry , Middle Aged , Prevalence , Treatment OutcomeABSTRACT
BACKGROUND: Besides stricture formation, diminished esophageal motility after caustic esophageal burns also plays a role in the deterioration of the clinical course. In this study, we aimed to investigate the effect of caustic burn on the esophageal contractions and the effect of platelet-rich plasma (PRP) on these changes. METHODS: Twenty-one Wistar albino rats were divided into three groups [Sham operation (n = 8), caustic esophageal burn with NaOH (n = 6), PRP treatment after caustic burn (n = 7)]. After 3 weeks, esophagectomy was performed and contractions and EFS responses were evaluated in the organ bath. RESULTS: KCl- and acetylcholine-induced responses were reduced in the Burn group, but increased in Sham and PRP groups (p < 0.05). EFS responses were higher in Burn group compared to the other groups. Response with L-arginine was increased in Burn group, but decreased in PRP group. There was more decrease in the contraction in Sham and PRP groups compared to the Burn group after SNP (sodium nitroprusside) incubation (p < 0.05). L-NAME (Nω-Nitro-L-arginine methyl ester) did not change the EFS responses in the Burn group, but EFS responses were decreased significantly in Sham and PRP groups (p < 0.05). EFS responses were decreased in all groups, but more in the Sham and PRP groups after Y-27632 (Rho-kinase inhibitor) incubation (p < 0.05). CONCLUSIONS: For the first time, we demonstrated that both cholinergic and non-adrenergic non-cholinergic mechanisms are responsible for the altered motility in corrosive esophageal injury. Our results suggest that PRP treatment may be helpful in regulating the esophageal motility and decreasing altered contractions in corrosive burns. This effect may also contribute to the reduction of stricture formation, especially by reducing inappropriate contractions of the esophageal wall during the post-burn healing phase.
Subject(s)
Autonomic Nervous System/drug effects , Burns, Chemical/complications , Caustics/adverse effects , Electric Stimulation/methods , Esophageal Diseases/chemically induced , Esophagus/injuries , Platelet-Rich Plasma/physiology , rho-Associated Kinases/antagonists & inhibitors , Amides/administration & dosage , Amides/therapeutic use , Animals , Arginine/administration & dosage , Arginine/adverse effects , Autonomic Nervous System/physiopathology , Burns, Chemical/pathology , Enzyme Inhibitors/administration & dosage , Enzyme Inhibitors/therapeutic use , Esophageal Diseases/drug therapy , Esophageal Diseases/metabolism , Esophageal Diseases/surgery , Esophageal Motility Disorders/drug therapy , Esophageal Motility Disorders/metabolism , Esophageal Motility Disorders/physiopathology , Esophageal Stenosis/chemically induced , Esophageal Stenosis/pathology , Esophagectomy/methods , Esophagus/pathology , Pyridines/administration & dosage , Pyridines/therapeutic use , Rats , Rats, Wistar , Treatment Outcome , Wound Healing/drug effects , rho-Associated Kinases/metabolismABSTRACT
The jackhammer esophagus is a rare hypercontractile disorder and diagnosis is based on high-resolution manometry. Peroral endoscopic myotomy (POEM) of the spastic esophagus segments has been described. We report a pediatric patient with jackhammer esophagus that was treated endoscopically.
Subject(s)
Endoscopy, Gastrointestinal/methods , Esophageal Motility Disorders/surgery , Myotomy/methods , Adolescent , Botulinum Toxins, Type A/administration & dosage , Botulinum Toxins, Type A/therapeutic use , Esophageal Motility Disorders/drug therapy , Esophageal Motility Disorders/physiopathology , Esophagus/physiopathology , Female , Humans , Injections , Manometry , Neuromuscular Agents/administration & dosage , Neuromuscular Agents/therapeutic useSubject(s)
Antibodies, Antineutrophil Cytoplasmic , Antibodies, Antinuclear , Eosinophilia/diagnosis , Esophageal Motility Disorders/diagnosis , Fasciitis/diagnosis , Raynaud Disease/diagnosis , Adult , Antibodies, Antineutrophil Cytoplasmic/blood , Antibodies, Antinuclear/blood , Dermatologic Agents/administration & dosage , Eosinophilia/complications , Eosinophilia/drug therapy , Esophageal Motility Disorders/complications , Esophageal Motility Disorders/drug therapy , Fasciitis/complications , Fasciitis/drug therapy , Female , Humans , Methotrexate/administration & dosage , Prednisolone/administration & dosage , Raynaud Disease/complications , Raynaud Disease/drug therapyABSTRACT
BACKGROUND: Studies suggest that Ineffective Esophageal Motility (IEM) is the manometric correlate of Functional Dysphagia (FD). Currently, there is no accepted therapy for either condition. Buspirone is a serotonin modulating medication and has been shown to augment esophageal peristaltic amplitude in healthy volunteers. We aimed to determine if buspirone improves manometric parameters and symptoms in patients with overlapping IEM/FD. METHODS: We performed a prospective, double-blind, placebo-controlled, crossover-style trial of 10 patients with IEM/FD. The study consisted of two 2-week treatment arms with a 2-week washout period. Outcomes measured at baseline, end of week 2, and week 6 include high resolution esophageal manometry (HREM), the Mayo Dysphagia Questionnaire-14 (MDQ-14), and the GERD-HRQL. RESULTS: The mean age of our 10 patients was 53 ± 9 years and 70% were female. After treatment with buspirone, 30% of patients had normalization of IEM on manometry; however, there was 30% normalization in the placebo group as well. Comparing buspirone to placebo, there was no statistically significant difference in the HREM parameters measured. There was also no statistically significant difference in symptom outcomes for buspirone compared to placebo. Of note, patients had a statistically significant decrease in the total GERD-HRQL total score when treated with placebo compared to baseline levels. DISCUSSION: Despite previous data demonstrating improved esophageal motility in healthy volunteers, our study shows no difference in terms of HREM parameters or symptom scores in IEM/FD patients treated with buspirone compared to placebo. Further research is necessary to identify novel agents for this condition.
Subject(s)
Buspirone/therapeutic use , Esophageal Motility Disorders/drug therapy , Serotonin Receptor Agonists/therapeutic use , Cross-Over Studies , Double-Blind Method , Female , Humans , Male , Manometry , Middle Aged , Prospective Studies , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Animals , Rats , Esophageal Motility Disorders/drug therapy , Esophageal Motility Disorders/veterinary , Morphine/therapeutic use , Fluoroscopy , Barium Sulfate/therapeutic use , Congresses as Topic , Fluoroscopy/veterinary , Models, Animal , Injections, Intraperitoneal , Injections, Intraperitoneal/veterinary , Analysis of Variance , ColonABSTRACT
In achalasia and spastic esophageal motility disorders, botulinum toxin (botox) injection is considered an effective and low-risk procedure for short-term symptom relief. It is mainly offered to medically high-risk patients. However, no analysis of risks of botox injections has been performed. To determine the incidence and risk factors of procedure-related complications after esophageal botox injections, we analyzed the records of all patients undergoing botox injection therapy for esophageal motility disorders at four university hospitals in Europe and North America between 2008 and 2014. Complications were assigned grades according to the Clavien-Dindo classification. In 386 patients, 661 botox treatments were performed. Main indications were achalasia (51%) and distal esophageal spasm (DES) (30%). In total, 52 (7.9%) mild complications (Clavien-Dindo grade I) were reported by 48 patients, the majority consisting of chest pain or heartburn (29 procedures) or epigastric pain (5 procedures). No ulceration, perforation, pneumothorax, or abscess were reported. One patient died after developing acute mediastinitis (Clavien-Dindo grade V) following injections in the body of the esophagus. In univariate logistic regression, younger age was associated with an increased risk of complications (OR 1.43, 95%CI 1.03-1.96). Treatment for DES, injections into the esophageal body, more injections per procedure, more previous treatments and larger amount of injected botulinum toxin were no risk factors for complications. Esophageal botox injection seems particularly appropriate for high-risk patients due to low complication rate. However, it should not be considered completely safe, as it is associated with rare side effects that cannot be predicted.
Subject(s)
Botulinum Toxins/adverse effects , Esophageal Motility Disorders/drug therapy , Injections/adverse effects , Neurotoxins/adverse effects , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Botulinum Toxins/administration & dosage , Chest Pain/chemically induced , Esophageal Achalasia/drug therapy , Esophageal Spasm, Diffuse/drug therapy , Esophagus , Europe , Female , Heartburn/chemically induced , Hospitals, University , Humans , Logistic Models , Male , Middle Aged , Neurotoxins/administration & dosage , North America , Retrospective Studies , Risk Factors , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: Acute administration of the oral 5-HT1A receptor agonist buspirone, which is commonly used as an anxiolytic drug, may improve compromised lower esophageal sphincter function. In an open-label trial we assessed the effects of buspirone on esophageal motor function and symptoms in patients with esophageal involvement associated with systemic sclerosis (SSc). METHODS: Thirty consecutive patients with SSc and symptomatic esophageal involvement, despite treatment with proton pump inhibitors, underwent high resolution manometry and chest computed tomography for assessment of motor function and esophageal dilatation, respectively. Regurgitation, heartburn, dysphagia, and chest pain severity was subjectively scored by visual analog scales. Manometric parameters (primary endpoint) and symptom severity (secondary endpoint) were re-examined after 4-week daily administration of 20 mg buspirone. Other medications remained unchanged. RESULTS: Eight patients did not complete the trial because of buspirone-associated dizziness (n = 2), or nausea (n = 2), or reluctancy to undergo final manometry. In the remaining 22 patients lower esophageal sphincter (LES) resting pressure increased from 7.7 ± 3.9 to 12.2 ± 4.6 mmHg (p = 0.00002) after buspirone administration; other manometric parameters did not change. Statistical analysis revealed negative correlation between individual increases in resting LES pressure and supra-aortic esophageal diameter (r = -0.589, p = 0.017), suggesting a more beneficial effect in patients with less severely affected esophageal function. Heartburn and regurgitation scores decreased at 4 weeks compared to baseline (p = 0.001, and p = 0.022, respectively). CONCLUSION: Our findings warrant more conclusive evaluation with a double-blind controlled study; however, buspirone could potentially be given under observation for objective improvement in all patients with SSc who report reflux symptoms despite undergoing standard treatment. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02363478 Registered: 21-02-2014.
Subject(s)
Buspirone/therapeutic use , Esophageal Motility Disorders/drug therapy , Scleroderma, Systemic/drug therapy , Serotonin 5-HT1 Receptor Agonists/therapeutic use , Adult , Aged , Esophageal Motility Disorders/etiology , Esophagus/drug effects , Female , Humans , Male , Manometry , Middle Aged , Peristalsis/drug effects , Scleroderma, Systemic/complicationsABSTRACT
BACKGROUND AND AIM: Acotiamide is a newly developed prokinetic drug that is clinically used to treat functional dyspepsia (FD). The objective of this study was to assess the therapeutic effects of acotiamide in patients with esophageal motility disorders (EMDs). METHODS: Twenty-nine patients with both symptoms of FD and symptoms suspicious of EMDs were enrolled. Esophageal motility function was evaluated by high-resolution manometry before and after 2 weeks administration of acotiamide (100 mg) 3 times per day. RESULTS: Twenty-nine patients were diagnosed with achalasia (n = 4), esophagogastric junction outflow obstruction (EGJOO) (n = 6), absent peristalsis (n = 2), distal esophageal spasm (n = 4), frequently failed peristalsis (n = 7), weak peristalsis (n = 2) and 4 of them were found to be normal. An analysis in all 29 patients showed that acotiamide had no effects on based on distal contractile integral (DCI), basal lower esophageal sphincter (LES) pressure, or integrated relaxation pressure (IRP). Subgroup analysis, however, showed that acotiamide dramatically reduced IRP, from 19.5 (15.1-30.8) to 12.1 (5.6-16.4) mm Hg, and DCI, from 2,517.9 (1,451.0-8,385.0) to 1,872.5 (812.3-5,225.3) mm Hg·cm·s, in the 6 patients with EGJOO. CONCLUSIONS: Acotiamide potentially normalized impaired LES relaxation in patients with EGJOO, while having no effects on normal esophageal motility patterns. Acotiamide may be a promising treatment for EGJOO.