Traube M, Hongo M, Magyar L, McCallum R W
JAMA. 1984 Oct 5;252(13):1733-6.
We studied the esophageal effects of nifedipine in 20 patients with achalasia (20 mg sublingually) and nine patients with high-amplitude peristaltic esophageal contractions (nutcracker esophagus) (20 mg orally). In patients with achalasia, nifedipine decreased lower esophageal sphincter (LES) pressure by approximately 30%. In ten patients with achalasia, plasma nifedipine concentrations were 45.3 +/- 17.7 and 57.4 +/- 12.8 ng/mL (means +/- SEM) at 30 and 60 minutes, respectively, after drug administration. In patients with nutcracker esophagus, nifedipine decreased LES pressure by approximately 50% and contraction amplitude in the body of the esophagus by approximately 25%. After comparison was made with our previous results in normal subjects, we concluded that (1) nifedipine decreased LES pressure in patients with achalasia to a similar extent to that noted in normal subjects; (2) plasma concentrations measured after 20 mg of nifedipine given sublingually to achalasic patients were similar to those found under similar circumstances in normal subjects; and (3) nifedipine decreased LES pressure and contraction amplitude in patients with nutcracker esophagus to a greater extent than was found in normal subjects. These results suggest that double-blind, placebo-controlled clinical trials of nifedipine in the treatment of achalasia or nutcracker esophagus are indicated.
我们研究了硝苯地平对20例贲门失弛缓症患者（舌下含服20毫克）和9例高振幅食管蠕动收缩患者（胡桃夹食管，口服20毫克）食管的影响。在贲门失弛缓症患者中，硝苯地平使食管下括约肌（LES）压力降低了约30%。在10例贲门失弛缓症患者中，给药后30分钟和60分钟时，血浆硝苯地平浓度分别为45.3±17.7和57.4±12.8纳克/毫升（均值±标准误）。在胡桃夹食管患者中，硝苯地平使LES压力降低了约50%，食管体部收缩幅度降低了约25%。与我们之前在正常受试者中的结果进行比较后，我们得出以下结论：（1）硝苯地平使贲门失弛缓症患者的LES压力降低程度与正常受试者相似；（2）给贲门失弛缓症患者舌下含服20毫克硝苯地平后测得的血浆浓度与正常受试者在类似情况下测得的浓度相似；（3）硝苯地平使胡桃夹食管患者的LES压力和收缩幅度降低程度比正常受试者更大。这些结果表明，硝苯地平治疗贲门失弛缓症或胡桃夹食管的双盲、安慰剂对照临床试验是有必要的。
