Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0014848 (achalasia)
 2,804 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Calcium-channel blocking agents have a potential role in regulation of gastrointestinal tract function by decreasing smooth muscle contraction and possibly inhibiting cellular secretion. Most studies to date have concentrated on the ability of these drugs to inhibit smooth muscle contraction. Verapamil and diltiazem have been shown in animals (opossum, baboon) to produce decreased contractions in esophageal smooth muscle, resulting in a decreased amplitude of peristalsis and decreased lower esophageal sphincter pressures. In studies in man, oral doses of diltiazem and nifedipine have likewise been shown to have similar effects on the esophagus. At present, there is no experimental evidence of a major antisecretory effect of these drugs. In clinical trials, nifedipine has been shown to have a greater effect than placebo in improving symptoms in patients with achalasia, and diltiazem has been suggested as potential therapy in patients with chest pain secondary to excessive esophageal contraction. The precise role for calcium-channel blocking drugs in therapy of gastrointestinal disease is still being explored.
 ...
PMID:Calcium-channel blocking agents for gastrointestinal disorders. 388 16

The excellent safety and predictable efficacy of isosorbide dinitrate (ISDN) have been demonstrated repeatedly during the past 25 years in a number of studies in which the agent has been used alone or in combination with other antianginal agents. Clinical studies to investigate the additive or synergistic effect of ISDN have been difficult to conduct because of the complexity of protocol design and length of studies required. However, combination therapy is well accepted in the clinical practice of medicine and cardiology and is used to obtain additive therapeutic effects while minimizing the side effects. The addition of ISDN not only to other standard and proven antianginal agents but also to calcium antagonists should prove to be a fruitful area for further clinical research benefiting patients with angina pectoris (caused by either coronary artery spasm or occlusive coronary artery disease), hypertension, and congestive heart failure. Noncardiovascular uses of ISDN may include the treatment of hyperspasticity of other smooth muscle beds, such as esophageal spasm and achalasia.
 ...
PMID:Combination therapy with isosorbide dinitrate: current status and the future. 389 82

Before removing the diverticula (running suture for mucosa, interrupted stitches for the esophageal wall with resorbable material) a myotomy of the upper sphincter (pars inf. of the crycopharyngeal) muscle should be performed to restore the preoperative insufficient relaxation of the upper sphincter. The diffuse spasm shows a normal function of the LES; painful attacks can be treated by calcium antagonists or nitroglycerin. The achalasia can be treated either by endoscopic dilatation or myotomy to reduce the LES-pressure and restore the insufficient relaxation of the LES.
 ...
PMID:[Reconstruction of esophageal passage in functional disorders (achalasia, Zenker diverticulum, spasms)]. 393 98

Drugs which interfere with the voltage-activated inward displacement of calcium ions into excitable cells, including those of the myocardium, atrial and ventricular nodes, and smooth muscle cells, have become known as calcium antagonists. These drugs are a heterogeneous group, and differ from one another in chemistry, tissue specificity, potency and bioavailability. The prototype of the group is verapamil. Other calcium antagonists are nifedipine and diltiazem. The therapeutic applications of these compounds include the relief of angina pectoris, and the management of hypertension, ischaemic heart disease and, in certain instances, arrhythmias. Calcium antagonists are also useful in the management of oesophageal achalasia, Raynaud's disease, and hypertrophic obstructive cardiomyopathy, and may be of use in premature labour.
 ...
PMID:Calcium antagonists. 631 4

It is not surprising that calcium-channel blocking agents, which have numerous effects on various physiologic systems, have been employed for several "unapproved" uses. This manuscript reviews reports that have appeared within the last two years describing unapproved cardiovascular and noncardiovascular uses of the three available calcium-channel blocking agents. The cardiovascular uses discussed include hypertensive emergencies, pulmonary hypertension, congestive heart failure, aortic insufficiency, Raynaud's phenomenon, migraine headaches, antiplatelet effects and cardiac surgery. Areas of noncardiovascular use include muscular dystrophy, achalasia, esophageal spasm, dysmenorrhea, preterm labor, asthma, hyperuricemia, mania and depression and endocrinologic and oncologic conditions. While some of the data appear promising, other reports are conflicting and contradictory. Furthermore, because much of the information comes from poorly controlled trials or anecdotal reports, even the more promising uses must be studied further and compared with conventional therapy.
 ...
PMID:Promising uses of calcium-channel blocking agents. 637 47

Verapamil hydrochloride is an organic calcium antagonist that is known to decrease the contraction of smooth muscle. The purpose of our study was to determine if verapamil has a similar effect on the resting lower esophageal sphincter pressure in normal subjects and in patients with achalasia. Esophageal manometry was performed using a continuously perfused catheter assembly. Infusion of verapamil (0.15 mg/kg) over a 2-min period resulted in a statistically significant decrease in resting lower esophageal sphincter pressure in both normal subjects (n = 8) and patients with achalasia (n = 7) within 10 min postinfusion. This study suggests that verapamil may have potential as a drug therapy in treating the clinical symptoms of achalasia and diffuse esophageal spasm.
 ...
PMID:The effect of verapamil on the lower esophageal sphincter pressure in normal subjects and in achalasia. 665 Apr 65

The effect of nifedipine, one of calcium antagonists, was studied on esophageal function of 10 patients with achalasia. Lower esophageal sphincter pressure (LESP) was measured with constantly perfused catheter before and after sublingual administration of 10 mg nifedipine. Nifedipine decreased LESP both in achalasia patients and normal controls except one patient. The fall of LESP by nifedipine seems to correlate with initial resting LESP. A clinical trial of nifedipine on patients with achalasia was carried out taking nifedipine sublingually in a daily dosage of 30 to 60 mg before meal. Nifedipine therapy gave good results in 8 patients, and poor response in one and no effects in one patient. Nifedipine improved symptoms of achalasia, but did not improve the degree of esophageal dilatation. Side effect was observed in only one patient, which was flushing of extremities caused by vasodilation, and it is not hazardous to continue nifedipine therapy. Sublingual administration of nifedipine in patients with achalasia is very useful way of medical treatment in two respects, 1) nifedipine decreases LESP, and 2) sublingual administration does not need to pass through the drug through esophagogastric junction which pressure is abnormally high in achalasia patients.
 ...
PMID:[Clinical effect of nifedipine in patients with achalasia]. 714 40

The effect of a new calcium antagonist, nifedipine, which has a spasmolytic activity on smooth muscle cells, was studied on the esophageal function of 20 patients with achalasia of mild and moderate degree. The study was carried out by using constantly perfused catheters and recording the pressure variations at the lower esophageal sphincter, before and after sublingual administration of 10-20 mg of nifedipine. The drug significantly decreased the lower esophageal sphincter pressure for more than 1 h. A clinical trial was also carried out by assessing the improvement of symptoms in achalasia patients taking sublingually a dose of 10-20 mg of nifedipine before each meal. After 6-18 mo of nifedipine therapy these patients underwent a placebo treatment, whereas an additional group of 9 achalasia patients was treated first with placebo followed by nifedipine. The nifedipine treatment gave excellent or good results in a large majority of patients of both groups. The moderate results were only 5 and the poor responses only 3. The clinical improvement induced by nifedipine was statistically significant when compared, not only with the pretreatment clinical state, but also with the results of the placebo treatment. No tachyphylaxis and few side effects were seen either during the manometric recordings or the longest periods of therapy. This study suggests that nifedipine may be advantageously used in the medical treatment of achalasia of mild or moderate degree.
 ...
PMID:Clinical and manometric effects of nifedipine in patients with esophageal achalasia. 745 Apr 9

Swallowing is a complex mechanism that is based on the coordinated interplay of tongue, pharynx, and esophagus. Disturbances of this interplay or disorders of one or several of these components lead to dysphagia, non-cardiac chest pain, or regurgitation. The major esophageal motility disorders include achalasia, diffuse esophageal spasm, hypercontractile esophagus ("nutcracker esophagus"), and hypocontractile esophagus ("scleroderma esophagus"). Other esophageal diseases such as hypopharyngeal (Zenker's) diverticula or gastroesophageal reflux disease also may be sequelae of primary esophageal motility disorder. Finally, a substantial group of patients referred for evaluation of possible esophageal motor disorders have milder degrees of dysmotility--referred to as nonspecific esophageal motor disorder--that are of unclear clinical significance. Medical treatment of esophageal motility disorders involves the uses of agents that either reduce (anti-cholinergic agents, nitrates, calcium antagonists) or enhance (prokinetic agents) esophageal contractility. Despite the beneficial effect of the various drugs on esophageal motility parameters, the clinical benefit of medical treatment is often disappointing. From clinical and epidemiological studies there is some evidence for a "psychological" component in the pathogenesis or perception of esophageal symptoms. Further understanding of esophageal pathophysiology, as well as development of new receptor selective drugs, might increase our chances of successful treatment of esophageal motility disorders.
 ...
PMID:Medical treatment of esophageal motility disorders. 846 20

In reflux disease the authors emphasize the following diagnostic procedures: a satisfactory case-history, endoscopy, aimed biopsy, radiographic evidence of reflux, radionuclide reflux scintigraphy and pH-metry. As to subsidiary examinations, they recommend Bernstein's perfusion test. In 50% of the patients with non-coronary chest pain the complaints are caused by diseases of the oesophagus. The latter include achalasia, dysphagia, idiopathic diffuse spasm, hyperdynamic oesophagus and irritable oesophagus. In the treatment of reflux disease the stage of the disease is decisive. Treatment is prolonged and the doses of drugs are higher than in duodenal ulcers. The basis are H2 blockers. In severe forms treatment with omeprazole is indicated. Surgery is indicated only in severe mucosal complications. In achalasia of the oesophagus this is disruption of the sphincter by the method of pneumatic dilatation or surgical myotomy. Idiopathic diffuse spasm and other disorders of oesophageal motility respond in different ways to treatment with calcium autagonists and nitrate treatment.
 ...
PMID:[Diagnosis and therapy of esophageal diseases]. 850 59


<< Previous 1 2 3 4 Next >>