Abstract :
Background: Nitric oxide (NO) has been showed to modulate esophageal peristalsis contractions in
healthy humans.
Objective: To study if isosorbide dinitrate (ISDN) which is an exogenous NO donor can restore esoph-
ageal peristalsis contractions in symptomatic patients with distal esophageal spasm.
Methods: Ten patients were randomized to undergo high resolution manometry (HRM) with ISDN
spray (1.25 mg/puff) or normal saline (NSS) spray, in 2 times at least 48 hours apart, in a crossover randomized
controlled trial (assessor blind). For each HRM study, esophageal contractions in response to 12 wet swallows were
studied at baseline, after the first 1-puff and the second 1-puff of test agents. Esophageal contraction parameters
were analyzed using ManoView analysis software version 2.0.1.
Results: Prevalence of esophageal peristalsis contractions was similar at baseline (p>0.05) and increased
by ISDN significantly only after the first dose (65% vs. 50%, p=0.045) but not the second dose compared to NSS
(p>0.05). ISDN decreased esophageal distal contractile integral (DCI) after the first dose (1421 ± 839 vs. 2363 ± 1581
mmHg s-1cm-1, p=0.050) and significantly decreased DCI after the second dose (1399 ± 739 vs. 2409 ± 1289 mmHg
s-1cm-1, p=0.006) compared to NSS. ISDN significantly increased residual upper esophageal sphincter (UES)
relaxation pressure after the first dose (0.5 ± 3.7 vs. –4.0 ± 6.2 mmHg, p=0.026) and the second dose (1.2 ± 4.5 vs.
–3.9 ± 6.5 mmHg, p=0.027) compared to NSS. However, there was no significant difference of pressurization front
velocity (PFV), 4-second integrated relaxation pressure (IRP) and UES resting pressure comparing between ISDN
and NSS at baseline, after the first dose and the second dose of the test agents (p>0.05).
Conclusions: In patients with distal esophageal spasm, proportion of esophageal peristalsis contrac-
tion was increased overtime after HRM catheter insertion. ISDN significantly improved esophageal peristalsis
contractions earlier than NSS, decreased DCI or force of contractions, and increased residual UES relaxation pres-
sure. This study suggests the role of central nervous system or esophageal adaptation to local stimulus and exog-
enous NO on the restoration of esophageal peristalsis contractions in patients with distal esophageal spasm. |
file/Thai-Journal-of-gastroenterology-vol-15-no-1-4720282.pdf