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Esophageal Motility Disorders Medication

  • Author: Eric A Gaumnitz, MD; Chief Editor: Julian Katz, MD  more...
 
Updated: Dec 29, 2015
 

Medication Summary

Drug treatment targets relaxation of the smooth muscle of the LES and esophageal body for symptomatic relief. In a subset of patients with esophageal body spastic motility disorders, relieving anxiety has been shown to improve symptoms. Commonly used medications for patients with esophageal motility disorders include calcium channel blockers, smooth muscle relaxants, anticholinergics, and antianxiety medications. No one single drug has proven efficacy in the treatment of spastic motility disorders.

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Calcium channel blockers

Class Summary

Inhibit calcium ions from entering slow channels, select voltage-sensitive areas, or vascular smooth muscle.

Nifedipine (Adalat, Procardia)

 

Relaxes smooth muscles, including those of the LES and esophageal body.

Amlodipine (Norvasc)

 

Relaxes smooth muscles, including those of the LES and esophageal body.

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Vasodilators

Class Summary

Used for smooth muscle relaxation effects.

Isosorbide dinitrate (Isordil, Dilatrate-SR)

 

Relaxes smooth muscles, including those of the LES and esophageal body.

Nitroglycerin sublingual (Nitro-Bid, Deponit, Nitro-Dur)

 

Relaxes smooth muscle all over the body, including those of the LES and esophageal body.

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Anticholinergics

Class Summary

Inhibit the cholinergic effect on the gut to induce relaxation.

Dicyclomine (Bentyl)

 

Treats GI motility disturbances. Blocks action of acetylcholine at parasympathetic sites in secretory glands, smooth muscle, and CNS.

Hyoscyamine (Levbid)

 

Blocks action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and CNS, which, in turn, has antispasmodic effects. SL tabs may be administered orally, sublingually, or chewed.

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Anxiolytics

Class Summary

Relief of anxiety related to symptoms experienced by some patients with esophageal motility disorders, resulting sometimes in symptomatic relief.

Alprazolam (Xanax)

 

Binds receptors at several sites within the CNS, including the limbic system and reticular formation. Effects may be mediated through GABA receptor system.

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Tricyclic antidepressants

Class Summary

Used in chronic pain management for noncardiac chest pain unresponsive to other treatment modalities.

Amitriptyline (Elavil)

 

Has analgesic effects for some forms of chronic and neuropathic pain.

Nortriptyline (Pamelor)

 

Has demonstrated effectiveness in the treatment of chronic pain. By inhibiting the reuptake of serotonin and/or norepinephrine by the presynaptic neuronal membrane, this drug increases the synaptic concentration of these neurotransmitters in the CNS. Pharmacodynamic effects (eg, desensitization of adenyl cyclase, down-regulation of beta-adrenergic and serotonin receptors) also appear to play a role in its mechanism of action.

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Acetylcholine release inhibitors

Class Summary

Local anticholinergic use at the LES.

Botulinum toxin (BOTOX)

 

Binds to receptor sites on motor nerve terminals and inhibits release of acetylcholine, which, in turn, inhibits transmission of impulses in neuromuscular tissue.

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Antiparasitic agents

Class Summary

For reduction in parasitemia and improvement of clinical signs and symptoms of Chagas disease.

Nifurtimox (Lampit)

 

5-nitrofuran derivative that is the current drug of choice in the United States for treatment of acute Chagas disease (American trypanosomiasis) due to T cruzi infection. Although the use of this drug is effective in reducing or eliminating parasitemia and clinical symptoms in acute disease, whether chronic sequelae are reliably prevented is unclear. In the chronic stage, a long-term parasitological cure may not be achieved, and the drug may not alter the course of the disease significantly.

Dose adjustments may be indicated in renal or hepatic disease. The toxicity of nifurtimox also is a limitation, and geographic variations in response to nifurtimox in patients with chronic disease have been reported.

Benznidazole (Radanil, Rochagan, Ragonil)

 

A 2-nitroimidazole derivative that has inhibitory effect on protein synthesis and ribonucleic acid synthesis in T cruzi cells.

Benznidazole chemotherapy has been recommended as an alternative choice for treatment of the acute and indeterminate phases of Chagas disease, but it does not appear to offer a significant efficacy or toxicity advantage over nifurtimox. Benznidazole may be preferable in some regions based on experience with local strains. The propensity of both of these agents to induce chromosomal aberrations requires further study.

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Contributor Information and Disclosures
Author

Eric A Gaumnitz, MD Professor of Medicine, Division of Gastroenterology, University of Wisconsin School of Medicine; Program Director, Gastroenterology and Hepatology Fellowship, University of Wisconsin School of Medicine and Public Health; Director, Motility Unit, University of Wisconsin Hospitals

Eric A Gaumnitz, MD is a member of the following medical societies: American Gastroenterological Association, American Neurogastroenterology and Motility Society, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Coauthor(s)

Abdullah Fayyad, MD, MBBS Gastroenterology Staff, Private Practice, Digestive and Liver Disease Consultants

Abdullah Fayyad, MD, MBBS is a member of the following medical societies: American Gastroenterological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Julian Katz, MD Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

Ronnie Fass, MD, FACP, FACG Chief of Gastroenterology, Head of Neuroenteric Clinical Research Group, Southern Arizona Veterans Affairs Health Care System; Professor of Medicine, Division of Gastroenterology, University of Arizona School of Medicine

Ronnie Fass, MD, FACP, FACG is a member of the following medical societies: American College of Gastroenterology, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, American Neurogastroenterology and Motility Society, American Society for Gastrointestinal Endoscopy, Israeli Medical Association

Disclosure: Received grant/research funds from Takeda Pharmaceuticals for conducting research; Received consulting fee from Takeda Pharmaceuticals for consulting; Received honoraria from Takeda Pharmaceuticals for speaking and teaching; Received consulting fee from Vecta for consulting; Received consulting fee from XenoPort for consulting; Received honoraria from Eisai for speaking and teaching; Received grant/research funds from Wyeth Pharmaceuticals for conducting research; Received grant/research funds f.

Acknowledgements

Simmy Bank, MD Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine

Disclosure: Nothing to disclose.

References
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The typical picture of achalasia. Note the "bird-beak" appearance of the lower esophageal sphincter (LES), with a dilated, barium-filled esophagus proximal to it. Image courtesy of Andrew Taylor, MD, Professor, Abdominal Imaging, Department of Radiology, University of Wisconsin Medical School, Madison.
The response to amyl nitrate (a smooth muscle relaxant), with partial relaxation of the lower esophageal sphincter (LES), allows some barium to pass through it into the stomach. Image courtesy of Andrew Taylor, MD, Professor, Abdominal Imaging, Department of Radiology, University of Wisconsin Medical School, Madison.
Esophagram of a 65-year-old man with rapid-onset dysphagia over 1 year. Although esophagram shows a typical picture of achalasia, this patient had adenocarcinoma of the gastroesophageal junction. This is an example of pseudoachalasia, which reinforces the absolute need for esophagogastroduodenoscopy (EGD) in patients with radiologic diagnosis of achalasia. Image courtesy of Andrew Taylor, MD, Professor, Abdominal Imaging, Department of Radiology, University of Wisconsin Medical School, Madison.
An esophagram demonstrating the corkscrew esophagus picture observed in a patient with manometry confirmed findings of diffuse esophageal spasm (DES). Image courtesy of Andrew Taylor, MD, Professor, Abdominal Imaging, Department of Radiology, University of Wisconsin Medical School, Madison.
Response to amyl nitrate, with disappearance of the spasm on esophagram. Image courtesy of Andrew Taylor, MD, Professor, Abdominal Imaging, Department of Radiology, University of Wisconsin Medical School, Madison.
Normal manometry results show normal esophageal body peristalsis with normal lower esophageal sphincter (LES) pressure and relaxation. The LES pressure tracing is at the level of the sleeve (tracing 6).
Achalasia manometry picture Note the nonrelaxing lower esophageal sphincter (LES) and the absence of esophageal body peristalsis. The LES pressure tracing is at the level of the sleeve (tracing 6).
Manometry demonstrates diffuse esophageal spasm with simultaneous contractions of the esophagus observed throughout the tracing. The lower esophageal sphincter (LES) pressure tracing is at the level of the sleeve (tracing 6).
 
 
 
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