Oesophageal Motor Changes in Systemic Disease

Atkinson, Michael

doi:10.1016/s0300-5089(21)00138-3

Cited by 10 publications

(1 citation statement)

References 24 publications

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“…It is symptomatic relief which the patient is seeking when he requests medical advice. Many patients with severe symptoms have little objective evidence of oesophagitis at endoscopy and, conversely, patients with severe oesophagitis may deny any related symptoms [1]. To clarify the role of Cimetidine in the management of patients with symptomatic gastro-oesophageal reflux we have undertaken a controlled double-blind study.…”

Section: Introductionmentioning

confidence: 99%

Cimetidine for the Treatment of Symptomatic Gastro‐oesophageal Reflux

Greaney

Irvin

1981

Int J Clinical Practice

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Thirty patients with symptomatic gastrooesophageal reflux received Cimetidine 1.6 G daily or placebo for six weeks in a double blind study. Twenty patients completed the trial satisfactorily and II of these had been prescribed Cimetidine and 9 placebo. Although there was a suggestion that Cimetidine produced greater symptomatic relief this did not reach statistical significance. Similarly, there was no statistically significant difference between the two groups in the number of antacid tablets consumed. Endoscopic and acid perfusion studies did not reveal any meaningful differences between the two treatment groups. When seen three months after completion of the study, 4 out of 6 patients in the Cimetidine group had a recurrence of symptoms.

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Section: Introductionmentioning

confidence: 99%

Cimetidine for the Treatment of Symptomatic Gastro‐oesophageal Reflux

Greaney

Irvin

1981

Int J Clinical Practice

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Nifedipine and esophageal dysfunction in progressive systemic sclerosis. A controlled manometric study

Kahan¹,

Bour²,

Couturier³

et al. 1985

Arthritis & Rheumatism

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We evaluated the effect of the calcium channel blocking agent, nifedipine, on esophageal dysfunction in 15 patients with progressive systemic sclerosis, using a double-blind, randomized, crossover, placebo-controlled manometric study. Nifedipine significantly decreased lower esophageal sphincter pressure in these patients; this reduced lower esophageal sphincter pressure may cause gastroesophageal reflux. Thus, nifedipine may have detrimental effects on progressive systemic sclerosis patients.The pathogenesis of esophageal dysfunction in progressive systemic sclerosis (scleroderma; PSS) has not been well elucidated (1,2). PSS is characterized by vascular and microvascular abnormalities (1-4), excessive fibroblastic activity (5,6), and collagen deposition in numerous organs (1,2,7). The possibility that the lesions in target organs are a reflection of a primary fibrous tissue overgrowth leading to secondary vascular compromise has not been ruled out. Nevertheless, a growing body of evidence based on studies of several organs involved in PSS suggests that the vascular system per se may be the primary target organ and that the lesions are a manifestation of focal ischemic injury resulting from functional, with or without accompanying structural, vascular disease (~4 , 8 4 4 ) .Nifedipine, a calcium channel blocking agent, is effective in the treatment of coronary vasospasm ( I 5-18). We (19-21) and others (22)(23)(24)(25) have shown that nifedipine is effective in the treatment of idiopathic Raynaud's phenomenon and Raynaud's phenomenon occurring with progressive systemic sclerosis. Thus, if a microvascular abnormality is a contributor to the pathogenesis of scleroderma, nifedipine may be useful in the treatment of patients with early disease.However, nifedipine may have detrimental effects caused by its direct action on the lower esophageal sphincter. The actions of nifedipine on smooth muscle cells are well documented (15)(16)(17)(18). Several studies have shown that the drug decreases the lower esophageal sphincter pressure (LESP) in patients with achalasia (26,27). If nifedipine also decreases the LESP in patients with progressive systemic sclerosis, this could lead to gastroesophageal reflux.In the present investigation, we used a controlled, double-blind, randomized, crossover manometric study to evaluate the effect of nifedipine on I5 patients with progressive systemic sclerosis and esophageal dysfunction. Our trial demonstrates that nifedipine significantly decreases the lower esophageal sphincter pressure in patients with PSS. PATIENTS AND METHODSPatients. Fifteen patients with progressive systemic sclerosis and diffuse scleroderma were studied. All patients satisfied the American Rheumatism Association preliminary criteria for classification of definite systemic sclerosis (28). None of the patients had the CREST syndrome variant (calcinosis, Raynaud's phenomenon, esophageal dysmo-NIFEDIPINE IN PSS 49 1 tility, sclerodactyly, telangiectasias) of PSS (29). The presence of the esophageal symptoms of heartbur...

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Gastroenterology and the Elderly

Sheehy

1983

Contemporary Geriatric Medicine

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Oesophageal Motor Changes in Systemic Disease

Cited by 10 publications

References 24 publications

Cimetidine for the Treatment of Symptomatic Gastro‐oesophageal Reflux

Cimetidine for the Treatment of Symptomatic Gastro‐oesophageal Reflux

Nifedipine and esophageal dysfunction in progressive systemic sclerosis. A controlled manometric study

Gastroenterology and the Elderly

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