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Diltiazem therapy for symptoms associated with nutcracker esophagus
E L Cattau1, D O Castell, D A Johnson
1National Naval Medical Center, Bethesda, Maryland.
The American Journal of Gastroenterology
|March 11, 1991
Summary
Diltiazem, an oral calcium channel blocker, significantly reduced chest pain and esophageal contraction pressure in patients with nutcracker esophagus. This preliminary study suggests diltiazem may be an effective treatment for this condition.
Area of Science:
- Gastroenterology
- Pharmacology
Background:
- Nutcracker esophagus is characterized by high amplitude esophageal contractions, often causing noncardiac chest pain and dysphagia.
- Current treatment options for nutcracker esophagus symptoms are limited.
Purpose of the Study:
- To evaluate the efficacy of diltiazem, an oral calcium channel blocker, in managing symptoms of chest pain and dysphagia in patients diagnosed with nutcracker esophagus.
Main Methods:
- A randomized, double-blind, cross-over trial was conducted with 22 patients.
- 14 patients completed the study, comparing 8 weeks of diltiazem (60-90 mg qid) with 8 weeks of placebo.
- Esophageal motility and symptom assessments were performed pre- and post-treatment.
Main Results:
- Diltiazem therapy significantly decreased mean distal esophageal peristaltic pressure compared to placebo (128 ± 20 mm Hg vs. 158 ± 16 mm Hg, p < 0.05).
- Mean chest pain scores were significantly lower during diltiazem treatment than with placebo (p < 0.05).
- A similar, though not statistically significant, improvement was observed in the subset of patients meeting diagnostic criteria.
Conclusions:
- Oral diltiazem appears to be a promising treatment for noncardiac chest pain associated with nutcracker esophagus.
- The therapeutic effect is linked to a significant reduction in esophageal contraction pressure.