Proximal esophageal contraction after induction of ineffective distal contraction by sildenafil in healthy volunteers

Abstract

Background Proximal esophagus is composed of striated muscle replaced by smooth muscle in the distal section. Sildenafil, an inhibitor of phosphodiesterase type 5, causes a decrease in the amplitude of contractions in distal smooth muscle esophagus, with no effect on the proximal esophageal striated muscle. The aim of this investigation was to evaluate the hypothesis that proximal contractions are affected by changes in distal contractions caused by sildenafil. Methods Esophageal motility was assessed by high resolution manometry in 22 healthy volunteers (12 women) aged 22-50 years (mean 38.1±7.7 years). All volunteers performed, in the sitting position, 10 swallows of liquid (5 mL of saline) and 10 swallows of solid boluses (1 cm 3 pieces of bread), before and after ingestion of 50 mg of sildenafil. We evaluated the proximal esophageal contractions in response to the changes in distal esophageal motility induced by sildenafil. Results Sildenafil caused a significant reduction in distal contractile integral and integrated relaxation pressure in the lower esophageal sphincter. In the proximal esophagus the alteration in distal esophageal contraction caused a significant increase in contraction length, contractile integral, and contraction duration. Conclusion Induction of ineffective distal esophageal motility by sildenafil in healthy volunteers causes an increase in proximal esophageal motility, suggesting that proximal esophagus adapts to an induced impairment of distal esophageal motility.

Phosphodiesterase 5 (PDE-5) inhibitors (sildenafil, tadalafil, and vardenafil) effects on esophageal motility: a systematic review

“…The included studies were published between 2000 and 2021. The study by Costa, T. (2020) was conducted in Brazil and had the largest sample size with 22 patients [ 15 ].…”

“…The LES residual pressure values were not significantly different between the sildenafil and placebo groups at the post-infusion period. In the Brazilian study [ 15 ] it was demonstrated a significant increase in proximal and also distal contractile integral after sildenafil intake. Contractile integral was defined as the amplitude of contraction * duration of contraction * length of contraction.…”