Comparative Study of the Effects of Cimetropium Bromide and Atropine on Human Esophageal Motor Functions

Abstract

The effects of atropine and cimetropium bromide, a new antimuscarinic compound with strong spasmolytic properties, were studied on human esophageal motility. Twenty healthy subjects underwent esophageal manometry with continuous monitoring of lower esophageal sphincter pressure (LESP), and of amplitude, duration and velocity of contractions of the esophageal body. After a 30-min basal period, atropine (12 µg/kg) or cimetropium (5 mg) were administered as an intravenous bolus in a cross-over random manner and the recording was continued for another 60 min. Twenty minutes after injection, atropine and cimetropium decreased maximally, in a similar extent, both the amplitude of contractions of the esophageal body (-65% of the basal values) and the LESP (-30% of the basal values). The duration and propagation velocity of the esophageal contractions did not change significantly after both drugs. Sixty minutes after injection of cimetropium, the amplitude of contractions of the esophageal body and LESP returned to basal values while atropine still reduced both variables. These findings indicate that cimetropium bromide has an inhibitory effect on LESP and on the amplitude of contractions of the esophageal body similar to atropine, but its action lasts less time.

Effects of two anticholinergic drugs, trospium chloride and biperiden, on motility and evoked potentials of the oesophagus

“…The observed decrease in the contraction amplitude of primary peristalsis or even an abolished peristalsis after TC and BIP is in line with the reported effects of other anticholinergic drugs such as atropine, scopolamine, hyoscyamine, cimetropium bromide and propantheline bromide 1 –6 . TC, which cannot pass the blood–brain barrier due to its quaternary ammonium structure, 13 exerts its effect by blockade of the oesophageal muscarinergic M3 receptors of the smooth muscle, 16 while the site of action is unknown for BIP.…”

“…A shortened duration was found after anticholinergic drugs in two studies, 1 , 6 while, in accordance with our study, no effect was observed by others 3 , . 4 The reason might be that it is difficult to measure correctly the duration of contractions with a very low amplitude. A more accurate measurement should be possible with a strain gauge electronic pressure device such as that used in our study.…”

“…Anticholinergic drugs are known to impair the motor function of the oesophagus by decreasing the amplitude of primary peristaltic pressure waves elicited by water swallows 1 –6 . Also, atropine has been shown to reduce the secondary oesophageal peristaltic response to balloon distension, intra‐oesophageal insufflation of air, and instillation of water 7 …”

Esophageal pharmacology and treatment of primary motility disorders

“…Cimetropium bromide (5 mg; i.v.) as a non‐selective antimuscarinic receptor antagonist reduced the amplitude of the esophageal contractions and the LESP to a similar extent and with fewer side‐effects, but with less duration than atropine (12 μ g/kg) in healthy volunteers 15 . Furthermore, cimetropium bromide (10 mg; i.v.)…”

Medical treatment of esophageal motility disorders

“…Cimetropium has been evaluated as a new anticholinergic agent for its effect on esophageal motility. Cimetropium bromide (5 mg) as a nonselective antimuscarinic receptor antagonist reduced the amplitude of esophageal contractions and the LESP to a similar extent but with less duration than atropine (12 Ixg/kg) [7].…”