EFFECTS OF TRANSDERMAL NICOTINE ON LOWER ESOPHAGEAL SPHINCTER AND ESOPHAGEAL MOTILITY

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.