ISSN:
1573-2568
Keywords:
Chagas' disease
;
gastroesophageal reflux
;
gastric emptying
;
scintigraphy
;
esophageal motor disorder
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract The effect of isosorbide dinitrate (ISD) on gastroesophageal reflux and gastric emptying during the 24-min period following a liquid meal was studied in healthy volunteers, Chagas' disease patients with normal esophageal motility (CD-1 group), and Chagas' disease patients with esophageal dysmotility (CD-2 group) with dynamic scintigraphy. At random, on two separate days, the subjects received 5 mg isosorbide dinitrate or an identical-appearing placebo tablet, by the sublingual route, and ingested a liquid test meal containing [99mTc]phytate colloid before scintigraphic studies were performed. Gastroesophageal reflux episodes were more frequent (P=0.016) and gastroesophageal reflux indexes were greater (P〈0.010) after isosorbide dinitrate than after placebo in CD-2 group (N=15) but not in healthy volunteers (N=14) or CD-1 group (N=9); six of seven CD-2 patients presenting with gastroesophageal reflux after isosorbide dinitrate had abnormal clearance of refluxate. Gastric emptying was similar in healthy volunteers (N=13), CD-1 patients (N=6), and CD-2 patients (N=13), and no effect of isosorbide dinitrate on it was detected in any of the groups. In separate studies, 5 mg isosorbide dinitrate reduced the lower esophageal pressure (P〈0.01) in seven CD-2 patients. These results indicate that ISD increases the tendency towards GER in CD-2 patients, but not in healthy volunteers or CD-1 patients. This effect is probably related to an exceedingly intense relaxation of the LES caused by ISD in CD-2 patients. Considering the role of the destruction of the intramural neurons in the pathogenesis of the esophageal motor disorder in Chagas' disease, these findings are likely to be a consequence of the loss of the normal neural influences on the lower esophageal sphincter in Chagas' disease.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF02063962
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