Sc. Kadakia et al., EFFECTS OF TRANSDERMAL NICOTINE ON LOWER ESOPHAGEAL SPHINCTER AND ESOPHAGEAL MOTILITY, Digestive diseases and sciences, 41(11), 1996, pp. 2130-2134
Cigarette smoking has been shown to decrease lower esophageal sphincte
r pressure (LESP) by 19-42%. This decrease in LESP may be due to nicot
ine in the cigarette smoke or substances other than nicotine. The aim
of this study was to evaluate the effects of a nicotine patch on esoph
ageal motility since nicotine patches are devoid of ail toxins present
in the cigarette smoke except the nicotine. Ten healthy nonsmoking vo
lunteers underwent baseline esophageal manometry. Esophageal manometry
was repeated after placing a nicotine transdermal patch (Nicotrol) de
signed to deliver 15 mg of nicotine per day. The parameters that were
compared included LESP by rapid pull-through (LESP-RPT) and station pu
ll-through (LESP-SPT), LES relaxation, and velocity, amplitude, and du
ration of esophageal contractions. Plasma nicotine and cotinine levels
were measured prior to baseline manometry and after 12 hr of placing
the nicotine patch. the LESP-RPT decreased by 31% from 17.4 +/- 6.1 to
12.1 +/- 3.3 (P = 0.013) and the LESP-SPT by 27% from 13.4 +/- 5.4 to
9.8 +/- 4.8 (P = 0.029) after the nicotine patch. LES relaxation was
present in 100% before and after nicotine patch. There were no signifi
cant differences in velocity, duration, and amplitude of esophageal co
ntractions after the nicotine patch. Plasma nicotine and cotinine was
absent in all subjects at baseline but was significantly elevated afte
r 12 hr of nicotine patch. Transdermal delivery of nicotine results in
a significant reduction in LESP in healthy subjects without effecting
LES relaxation or esophageal body motility.