Smooth Muscle Relaxants

After the introduction of calcium channel blockers to medical practice it was discovered that sublingual administration of these drugs decreases LES resting pressure transiently. Although some patients do seem to respond symptomati-cally to smooth muscle relaxant therapy, the benefit is usually partial in degree and often diminishes over time. Also high doses may be required to obtain a substantial symptomatic response, and patient tolerance for the vasodilatory effect of these drugs, even in standard doses, may be limited. Ironically, there is evidence that the older long acting nitrates may have more profound effects on the esophageal muscle function than do calcium channel blockers.

TABLE 19-1. Therapeutic Options in Achalasia

• Oral or sublingual smooth muscle relaxants*

• Intrasphincteric botulinum toxin injection

• Large-caliber balloon dilatation

• Surgical myotomy

*Usually not feasible as long term treatment.

In clinical practice, patients generally have had symptoms

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