Esophageal Motility Disorders Medication

Updated: Dec 29, 2017
  • Author: Eric A Gaumnitz, MD; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Medication

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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