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

Marzio, L.; Grossi, Laurino; DeLaurentiis, Michelino; Cennamo, L; Lapenna, Domenico; Cuccurullo, Franco

doi:10.1007/bf02088038

Cited by 33 publications

(12 citation statements)

References 15 publications

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“…Medications used include anticholinergics (atropine, dicyclo mine, cimetropium bromide), calcium chan nel blockers (diltiazem. nifedipine, verapam il), nitrates (amyl nitrate, sublingual nitroglyc erine, isosorbide dinitrate), p-adrenergic ago nists (terbutaline) and theophylline [62,63,149,[158][159][160][161][162][163][164][165][166][167][168][169][170][171][172]. All lower LES resting pressure but do not improve LES relaxation.…”

Section: Pharmacologic Therapymentioning

confidence: 99%

Achalasia: What’s New in Diagnosis and Treatment?

Birgisson

Richter²

1997

Dig Dis

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Section: Pharmacologic Therapymentioning

confidence: 99%

Achalasia: What’s New in Diagnosis and Treatment?

Birgisson

Richter²

1997

Dig Dis

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“…Current oral drugs used to treat AC include nitrates, calcium channel blockers, phosphodiesterase inhibitors, and some others (butylscopolamine, nifedipine, verapamil, carbutoerol, terbutaline, aminophylline, nitroglycerin, vasoactiveintestinalpeptide, cimetropium, loperamide, isosorbide, and sildenafil). [63][64][65][66][67][68][69][70][71][72][73][74][75] These drugs transiently relax LES smooth muscle and facilitate esophageal emptying.…”

Section: Quality Of Evidence: 2+ Classification Of Recommendation: Amentioning

confidence: 99%

Management of achalasia cardia: Expert consensus statements

Ramchandani

Reddy

Nabi

et al. 2018

J of Gastro and Hepatol

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Achalasia cardia (AC) is a frequently encountered motility disorder of the esophagus resulting from an irreversible degeneration of neurons. Treatment modalities are palliative in nature, and there is no curative treatment available for AC as of now. Significant advancements have been made in the management of AC over last decade. The introduction of high resolution manometry and per-oral endoscopic myotomy (POEM) has strengthened the diagnostic and therapeutic armamentarium of AC. High resolution manometry allows for the characterization of the type of achalasia, which in turn has important therapeutic implications. The endoscopic management of AC has been reinforced with the introduction of POEM that has been found to be highly effective and safe in palliating the symptoms in short-term to mid-term follow-up studies. POEM is less invasive than Heller's myotomy and provides the endoscopist with the opportunity of adjusting the length and orientation of esophageal myotomy according to the type of AC. The management of achalasia needs to be tailored for each patient, and the role of pneumatic balloon dilatation, POEM, or Heller's myotomy needs to be revisited. In this review, we discuss the important aspects of diagnosis as well as management of AC. The statements presented in the manuscript reflect the cumulative efforts of an expert consensus group.

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“…Furthermore, cimetropium bromide (10 mg; i.v.) potently reduced the increased LESP and induces a significant decrease in esophageal body wave pressure in patients with achalasia or hypercontractile esophagus, 16 , 17 but clinical data on cimetropium bromide action when given orally are still missing. The routine and long‐term clinical use of anticholinergic substances is limited by the systemic side‐effects of these drugs (dry mouth, tachycardia).…”

Section: Pharmacology Of the Esophagusmentioning

confidence: 99%

Esophageal pharmacology and treatment of primary motility disorders

Storr

Allescher

1999

Diseases of the Esophagus

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Swallowing is a complex mechanism based on the coordinated collaboration of tongue, pharynx and esophagus. Disturbances of this interplay or disorders of one or several of these components lead to dysphagia, non-cardiac chest pain or regurgitation. The major primary esophageal motility disorders--achalasia, diffuse esophageal spasm, hypercontractile esophagus ('nutcracker esophagus') and non-specific motility disorder--are of unknown etiology. Other esophageal diseases, such as cervical diverticula or gastroesophageal reflux disease, might also be caused by a primary esophageal motility disorder. Medical treatment of esophageal disorders with esophageal hyper- or dysmotility requires agents that reduce esophageal contractile force (anticholinergic agents, nitrates, calcium antagonists). Despite the beneficial effect of the various drugs on esophageal motility parameters, the clinical benefit of medical treatment of esophageal motility disorders is rather disappointing. Calcium channel antagonist, alone or in combination with anticholinergics or nitrates, can be used as a medical trial, especially in mild achalasia. However, medical therapy is clearly inferior to pneumatic balloon dilation therapy. Recently, botulinum toxin injection was suggested as a therapeutic option in achalasia patients with good results on lower esophageal sphincter pressure (LESP) and symptom scores that were similar to the results achieved by pneumatic balloon dilation. Hypercontractile esophagus shows a good manometric response to calcium channel antagonists, but only little clinical effect in terms of improvement of symptoms. Diffuse esophageal spasm is a relatively rare disease and few clinical studies are available. The use of calcium channel antagonists can be beneficial, at least in some patients with diffuse esophageal spasm. From clinical and epidemiological studies, there is some evidence of a 'psychological' component in the pathogenesis or perception of esophageal symptoms. There is some clinical benefit from centrally acting drugs such as benzodiazepines or antidepressants. With the exception of botulinum toxin for achalasia, medical therapy of primary esophageal motility disorders is rather limited and the clinical results are poor. Further understanding of esophageal pathophysiology as well as development of new receptor-selective drugs might increase our chances of a successful treatment of primary esophageal motility disorders.

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

Cited by 33 publications

References 15 publications

Achalasia: What’s New in Diagnosis and Treatment?

Achalasia: What’s New in Diagnosis and Treatment?

Management of achalasia cardia: Expert consensus statements

Esophageal pharmacology and treatment of primary motility disorders

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