Metoclopramide response in patients with early diffuse systemic sclerosis. Effects on esophageal motility abnormalities.

OBJECTIVE

To assess the metoclopramide response in patients with early diffuse systemic sclerosis (dSSc) and the acute effects of intravenous (IV) metoclopramide on the lower esophageal sphincter (LES).

METHODS

Twenty-one patients with early dSSc (mean age 41.4 +/- 9.8 yrs., mean disease duration 2.47 +/- 0.75 yrs.) were prospectively evaluated. Six patients with late dSSc (mean age 52.6 +/- 9.1 yrs., mean disease duration 9.5 +/- 2.5 yrs.) were used as control group. All underwent solid-state esophageal manometry at rest and 15 minutes later received 10 mg of metoclopramide in an intravenous single bolus.

RESULTS

We found that the mean LES pressures measured by the station pull-through technique significantly increased in both early and late dSSc patients after metoclopramide administration (p < 0.05). While early dSSc patients did improve the mean residual pressures (p < 0.05), late dSSc patients did not (p > 0.05). In the esophageal body (EB), the mean contractions amplitude at 18, 13, 8, and 3 cm above the LES was < 20 mm Hg for both groups. However, peristaltic contraction velocitiy was significantly higher in early dSSc patients (< 0.05) than in that with late dSSc (p > 0.05). Our study did not show any major differences when comparing both groups. No side effects were seen.

CONCLUSIONS

The results of our study show that metoclopramide may improve LES pressures in patients with early and late dSS. Metoclopramide improve the mean residual pressure in patients with early dSSc, but not in late dSSc patients. Although esophageal contractions amplitude were significantly improved, they did not achieve a pressure > 20 mm Hg. Because metoclopramide can be used orally, it may mitigate both dysphagia and heartburn.