Effect of Loperamide on Lower Oesophageal Sphincter Pressure in Idiopathic Achalasia

Penagini, Roberto; Bartesaghi, B.; Negri, Giampiero; Bianchi, P.

doi:10.3109/00365529409094887

Cited by 22 publications

(12 citation statements)

References 11 publications

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“…Sublingual calcium channel blockers (nifedipine) and sublingual isorbide dinitrates (nitrates) are the two most common medications used 56,57. Less commonly used medications include anticholinergics, beta-blockers, beta-adrenergic agonists (carbuterol, terbutaline, cimetropium bromide), nitroglycerine, and theophylline (aminophylline) 58–61…”

Section: Treatmentmentioning

confidence: 99%

A Controversy That Has Been Tough to Swallow: Is the Treatment of Achalasia Now Digested?

Roll

Rabl

Ciovica

et al. 2010

Journal of Gastrointestinal Surgery

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Esophageal achalasia is a rare neurodegenerative disease of the esophagus and the lower esophageal sphincter that presents within a spectrum of disease severity related to progressive pathological changes, most commonly resulting in dysphagia. The pathophysiology of achalasia is still incompletely understood, but recent evidence suggests that degeneration of the postganglionic inhibitory nerves of the myenteric plexus could be due to an infectious or autoimmune mechanism, and nitric oxide is the neurotransmitter affected. Current treatment of achalasia is directed at palliation of symptoms. Therapies include pharmacological therapy, endoscopic injection of botulinum toxin, endoscopic dilation, and surgery. Until the late 1980s, endoscopic dilation was the first line of therapy. The advent of safe and effective minimally invasive surgical techniques in the early 1990s paved the way for the introduction of laparoscopic myotomy. This review will discuss the most up-to-date information regarding the pathophysiology, diagnosis, and treatment of achalasia, including a historical perspective. The laparoscopic Heller myotomy with partial fundoplication performed at an experienced center is currently the first line of therapy because it offers a low complication rate, the most durable symptom relief, and the lowest incidence of postoperative gastroesophageal reflux.

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Section: Treatmentmentioning

confidence: 99%

A Controversy That Has Been Tough to Swallow: Is the Treatment of Achalasia Now Digested?

Roll

Rabl

Ciovica

et al. 2010

Journal of Gastrointestinal Surgery

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“…Isosorbide dinitrate was superior in reducing LES pressure and improving symptoms, but also had a higher rate of adverse effects than nifedipine. 10 . However, radionuclide measurement of oesophageal emptying still demonstrated considerable oesophageal retention in four patients with improved symptoms, and therapeutic failure necessitated pneumatic dilation in 6 of 15 patients.…”

Section: Introductionmentioning

confidence: 95%

Therapeutic options in oesophageal dysphagia

Tack

Zaninotto

2015

Nat Rev Gastroenterol Hepatol

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High-resolution manometry enables the categorization of patients with oesophageal dysphagia caused by oesophageal motility disorders into diagnostic categories according to the Chicago Classification. This Review provides an overview of the literature concerning treatment options for patients with dysphagia associated with achalasia, hypercontractile disorders and hypocontractility disorders of the oesophagus. In achalasia, pharmacotherapy and botulinum toxin are less effective than pneumatic dilation or surgical Heller myotomy, which had comparable efficacy in the largest controlled trial to date. Peroral endoscopic myotomy is a novel therapeutic modality that is currently being evaluated in controlled trials versus pneumatic dilation or surgical myotomy. A variety of medical treatments have been evaluated in hypermotility disorders, but only botulinum toxin injection yielded favourable results in a single controlled trial. Few studies have addressed the treatment of dysphagia in patients with oesophageal hypomotility. A variety of prokinetic agents have been studied, but there is no evidence of clinically relevant efficacy from controlled trials.

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“…The loperamide study controlled study in GERD patients mosapride (40 mg; q.i.d.) significantly reduced the acid reflux into the eso-further suggests that the morphine effect is most likely an action via central opioid receptors [44]. In a study phagus, proven by pH monitoring [53].…”

Section: Motilin Receptor Agonistsmentioning

confidence: 99%

“…This relaxant effect of loperamide could not be reversed by naloxone indicating an action other than ceptors suggesting a 5-HT 4 receptor heterogeneity within the gastrointestinal tract [38,70]. In a first clinical study on -opioid receptors [44]. Intraluminal infusion of loperamide at the level of the LES was ineffective sugmosapride showed a therapeutic effect on patients with GERD [69] and in a randomized, double-blind, placebo-gesting that the drug must undergo intestinal absorption to elicit its effect on the LES.…”

Section: Motilin Receptor Agonistsmentioning

confidence: 99%

Pathophysiology and Pharmacological Treatment of Gastroesophageal Reflux Disease

Storr

Meining

Allescher

2000

Dig Dis

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Gastroesophageal reflux disease (GERD) is one of the most common diagnoses in a gastroenterologist’s practice. Gastroesophageal reflux describes the retrograde movement of gastric contents through the lower esophageal sphincter (LES) to the esophagus. It is a common, normal phenomenon which may occur with or without accompanying symptoms. Symptoms associated with GERD include heartburn, acid regurgitation, noncardiac chest pain, dysphagia, globus pharyngitis, chronic cough, asthma, hoarseness, laryngitis, chronic sinusitis and dental erosions. The introduction of fiberoptic instruments and ambulatory devices for continuous monitoring of esophageal pH (24-hour pH monitoring) has led to great improvement in the ability to diagnose reflux disease and reflux-associated complications. The development of pathological reflux and GERD can be attributed to many factors. Pathophysiology of GERD includes incompetent LES because of a decreased LES pressure, transient lower esophageal sphincter relaxations (TLESRs) and deficient or delayed esophageal acid clearance. Uncomplicated GER may be treated by modification of life style and eating habits in an early stage of GERD. The various agents currently used for treatment of GERD include mucoprotective substances, antacids, H2 blockers, prokinetics and proton pump inhibitors. Although these drugs are effective, they do not necessarily influence the underlying causes of the disease by improving the esophageal clearance, increasing the LESP or reducing the frequency of TLESRs. The following article gives an overview regarding current concepts of the pathophysiology and pharmacological treatment of GERD.

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Effect of Loperamide on Lower Oesophageal Sphincter Pressure in Idiopathic Achalasia

Cited by 22 publications

References 11 publications

A Controversy That Has Been Tough to Swallow: Is the Treatment of Achalasia Now Digested?

A Controversy That Has Been Tough to Swallow: Is the Treatment of Achalasia Now Digested?

Therapeutic options in oesophageal dysphagia

Pathophysiology and Pharmacological Treatment of Gastroesophageal Reflux Disease

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