Gelfond M, Rozen P, Keren S, Gilat T
Gut. 1981 Apr;22(4):312-8. doi: 10.1136/gut.22.4.312.
The effect of a long-acting nitrate, isosorbide dinitrate (ID) 5 mg sublingually, on the lower oesophageal sphincter was tested in 24 patients with achalasia. The drug caused a reduction in LOS pressure in all cases. The mean LOS pressure fell from 46.32.7 mmHg to 15.31.8 mmHg (p less than 0.01). The pressure began to drop after several minutes, reaching its lowest levels after 15 minutes. This measured manometric effect lasted for 60 minutes or more in 10 patients studied. The reported clinic effect lasted for two to three hours, permitting the ingestion of a meal. Twenty-three patients were followed clinically for two to 19 months while receiving the drug three times daily before meals. Nineteen reported a marked to complete relief of dysphagia. Five of these patients had previous pneumatic dilatation, cardiomyotomy, or both, and had recurrence at time of study. Side-effect, mainly headache, were reported in eight patients. In six this was alleviated by substituting oral isosorbide dinitrate, 10 mg. Two patients became refractory to treatment after two to six months. The potential role of long-acting nitrates in the treatment of achalasia has yet to be established.
对24例贲门失弛缓症患者测试了长效硝酸盐类药物二硝酸异山梨酯（ID）舌下含服5毫克对食管下括约肌的作用。该药在所有病例中均导致食管下括约肌压力降低。食管下括约肌平均压力从46.3±2.7毫米汞柱降至15.3±1.8毫米汞柱（p<0.01）。压力在数分钟后开始下降，15分钟后降至最低水平。在接受研究的10例患者中，这种测得的测压效应持续60分钟或更长时间。所报道的临床效应持续两到三个小时，使患者能够进食。23例患者在每日三次饭前服用该药期间接受了两到19个月的临床随访。19例患者报告吞咽困难有明显至完全缓解。其中5例患者既往曾接受过气囊扩张术、贲门肌切开术或两者皆有，在研究时复发。8例患者报告有副作用，主要是头痛。6例通过改用口服二硝酸异山梨酯10毫克而症状缓解。2例患者在两到六个月后对治疗产生耐药。长效硝酸盐类药物在贲门失弛缓症治疗中的潜在作用尚未确立。
