EFFECT OF CIMETROPIUM BROMIDE ON ESOPHAGEAL MOTILITY AND TRANSIT IN PATIENTS AFFECTED BY PRIMARY ACHALASIA

The effect of cimetropium bromide, a new anticholinergic agent, in pat ients with primary achalasia was studied. Twenty such patients (12 fem ales and 8 males, mean age 38 years, range 15-56) were studied. Diagno sis was performed by radiology, endoscopy, and manometry. Lower esopha geal sphincter pressure and body wave amplitude were measured by means of a five-channel catheter constantly perfused by a low-compliance pn eumohydraulic pump. Patient received cimetropium bromide 10 mg intrave nously over 3 min or placebo in a double-blind manner. In five patient s esophageal transit evaluated by scintiscanning was studied on separa te occasions after cimetropium bromide or placebo. Baseline mean lower esophageal sphincter pressure was 46 +/- 5 mm Hg and mean amplitude o f body waves was 30 +/- 8 mm Hg. Cimetropium bromide induced a signifi cant decrease in sphincter pressure and body wave amplitude that measu red 13 +/- 3 mm Hg and 8 +/- 4 mm Hg, respectively, 15 min after the e nd of infusion. The decrease was maintained for 45 +/- 5 min. A marked reduction in repetitive body waves was also noted. Esophageal transit was also accelerated with cimetropium bromide. Maximal stomach radioa ctivity was observed after 8 +/- 1.8 sec while with placebo this was r eached after 65 +/- 1.5 sec (P < 0.01). It is concluded that cimetropi um bromide reduces LES pressure and shortens transit in primary esopha geal achalasia. It may be useful in the treatment of this esophageal m otility disorder.