Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2004;2004(1):CD002299.
doi: 10.1002/14651858.CD002299.pub2.

Nitrates for achalasia

Z H Wen  1 , E Gardener, Y P Wang
Affiliations

Nitrates for achalasia

Z H Wen et al. Cochrane Database Syst Rev. 2004.

Abstract

Background: Achalasia is a disease that impairs oesophageal motility. Though nitrates have been used to treat achalasia for a long time, the effectiveness of nitrates for achalasia is still controversial.

Objectives: To quantify short-term and long-term effects of nitrate therapy in patients with achalasia.

Search strategy: Trials were identified by searching the Cochrane Controlled Trials Register (Issue 4-2001), MEDLINE (1966-2001), EMBASE (1980-2001), LILACS - Latin American and Caribbean health science literature (1982-2001) and CBM-Chinese Biomedical database(1980-2000). Additionally, all references in the identified trials were checked for further relevant trials. An updated search was run on the Cochrane Library, MEDLINE, and EMBASE in September 2003 - no new trials were found.

Selection criteria: All randomised controlled trials involving achalasic patients given any type of nitrates were included.

Data collection and analysis: Data were extracted by two independent observers based on the intention to treat principle.

Main results: Two randomised cross-over studies were found, but no results are included. Due to the design of the studies and the method of reporting the results in the original paper it was not possible to extract the necessary information to examine any of the outcomes.

Reviewer's conclusions: We can conclude no implications for practice at this stage. Appropriately designed parallel group randomised controlled trials with long term follow-up are needed to determine the effects of nitrates.

PubMed Disclaimer

Conflict of interest statement

None known.

Update of

Similar articles

See all similar articles

Cited by

  • Tailoring Therapy for Achalasia.
    Richter JE. Richter JE. Gastroenterol Hepatol (N Y). 2020 May;16(5):249-257. Gastroenterol Hepatol (N Y). 2020. PMID: 34035727 Free PMC article.
  • Non-surgical treatment of esophageal achalasia.
    Annese V, Bassotti G. Annese V, et al. World J Gastroenterol. 2006 Sep 28;12(36):5763-6. doi: 10.3748/wjg.v12.i36.5763. World J Gastroenterol. 2006. PMID: 17007039 Free PMC article. Review.
  • Self-medication of achalasia with cannabis, complicated by a cannabis use disorder.
    Luquiens A, Lourenco N, Benyamina A, Aubin HJ. Luquiens A, et al. World J Gastroenterol. 2015 May 28;21(20):6381-3. doi: 10.3748/wjg.v21.i20.6381. World J Gastroenterol. 2015. PMID: 26034374 Free PMC article.
  • Management of primary achalasia: The role of endoscopy.
    Luján-Sanchis M, Suárez-Callol P, Monzó-Gallego A, Bort-Pérez I, Plana-Campos L, Ferrer-Barceló L, Sanchis-Artero L, Llinares-Lloret M, Tuset-Ruiz JA, Sempere-Garcia-Argüelles J, Canelles-Gamir P, Medina-Chuliá E. Luján-Sanchis M, et al. World J Gastrointest Endosc. 2015 Jun 10;7(6):593-605. doi: 10.4253/wjge.v7.i6.593. World J Gastrointest Endosc. 2015. PMID: 26078828 Free PMC article. Review.
  • Achalasia: The Current Clinical Dilemma and Possible Pathogenesis.
    Jia X, Chen S, Zhuang Q, Tan N, Zhang M, Cui Y, Wang J, Xing X, Xiao Y. Jia X, et al. J Neurogastroenterol Motil. 2023 Apr 30;29(2):145-155. doi: 10.5056/jnm22176. J Neurogastroenterol Motil. 2023. PMID: 37019860 Free PMC article. Review.
See all "Cited by" articles

References

References to studies included in this review

Gelfond 1982 {published data only}
    1. Gelfond M, Rozen P, Gilat T. Isosorbide dinitrate and nifedipine treatment of achalasia: a clinical, manometric and radionuclide evaluation. Gastroenterology 1982;83(5):963‐9. [MEDLINE: ] - PubMed
Wong 1987 {published data only}
    1. Wong RKH, Maydonovitch C, Garcia JE, Johnson LF, Castell DO. The effect of terbutaline sulfate, nitroglycerin, and aminophylline on lower esophageal sphincter pressure and radionuclide esophageal emptying in patients with achalasia. Journal of Clinical Gastroenterology 1987;9(4):386‐9. [MEDLINE: ] - PubMed

References to studies excluded from this review

Achkar 1995 {published data only}
    1. Achkar, E. Achalasia. Gastroenterologist. 1995;3(4):273‐88. - PubMed
Allescher 1993 {published data only}
    1. Allescher HD, Ravich WJ. Medical treatment of esophageal motility disorders. Dysphagia 1993;8(2):125‐34. - PubMed
Bassotti 1988 {published data only}
    1. Bassotti G, Gaburri M, Bucaneve G, Farroni F, Pelli MA, Morelli A. Effects of transdermal nitroglycerin on manometric and clinical parameters in patients with achalasia of the esophagus. Current Therapeutic Research 1988;44(3):391‐6.
Bassotti 1999 {published data only}
    1. Bassotti G, Annese V. Review article: pharmacological options in achalasia. Alimentary Pharmacology & Therapeutics. 1999;13(11):1391‐6. - PubMed
Bortolotti 1994 {published data only}
    1. Bortolotti M, Coccia G, Brunelli F, Sarti P, Mazza M, Bagnato F, Barbara L. Isosorbide dinitrate or nifedipine: which is preferable in the medical therapy of achalasia?. Italian Journal of Gastroenterology. 1994;26:379‐82. [MEDLINE: ] - PubMed
Bourgeois 1992 {published data only}
    1. Bourgeois N, Coffernils M, Sznajer Y, Panzer JM, Gelin M, Cremer M. Non‐surgical management of achalasia. Acta Gastroenterologica Belgica 1992;55(3):260‐3. [MEDLINE: ] - PubMed
Douthwaite 1943 {published data only}
    1. Douthwaite AH. Achalasia of cardia. Treatment with nitrites. Lancet 1943;2:353‐4.
Efrati 1996 {published data only}
    1. Efrati Y, Horne T, Livshitz G, Broide E, Klin B, Vinograd I. Radionuclide esophageal emptying and long‐acting nitrates (Nitroderm) in childhood achalasia. Journal of Pediatric Gastroenterology & Nutrition 1996;23(3):312‐5. [MEDLINE: ] - PubMed
Ferguson 1981 {published data only}
    1. Ferguson SC, Hodges K, Hersh T, Jinich H. Esophageal manometry in patients with chest pain and normal coronary arteriogram. American Journal Gastroenterology 1981;75(2):124‐7. [MEDLINE: ] - PubMed
Furuya 1995 {published data only}
    1. Furuya R, Kunimi M, Ihara F, Ishihara M, Mori K, Yoshiya K, et al. A case of vigorous achalasia, successfully treated with isosorbide dinitrate spray. Nippon Shokakibyo Gakkai Zasshi ‐ Japanese Journal of Gastroenterology. 1995;92(10):1765‐9. [MEDLINE: ] - PubMed
Gelfond 1981 {published data only}
    1. Gelfond M, Rozen P, Keren S, Gilat T. Effect of nitrates on LOS pressure in achalasia: a potential therapeutic aid. Gut 1981;22(4):312‐8. [MEDLINE: ] - PMC - PubMed
Ghosh 1994 {published data only}
    1. Ghosh S, Heading RC, Palmer KR. Achalasia of the oesophagus in elderly patients responds poorly to conservative therapy. Age & Ageing 1994;23(4):280‐2. [MEDLINE: ] - PubMed
Hildebrand 1993 {published data only}
    1. Hildebrand T, Podracky J, Zakuciova M. [Diagnosis and therapy of esophageal diseases]. Vnitrni Lekarstvi 1993;39(2):132‐5. - PubMed
Kikendall 1980 {published data only}
    1. Kikendall JW, Mellow MH. Effect of sublingual nitroglycerin and long‐acting nitrate preparations on esophageal motility. Gastroenterology 1980;79:703‐706. - PubMed
Krivchenya 1990 {published data only}
    1. Krivchenya D, Almashii GG, Yurchenko NI, Dubrovin AG, Brusilovskaya GA, Palkina IS. Diagnosis and treatment of esophageal achalasia in children. Grudnaia i Serdechno‐Sosudistaia Khirurgiia. 1990;3:45‐48. - PubMed
Ona 1980 {published data only}
    1. Ona FV, Polintan LS. Vigorous achalasia manometric response to atropine and nitroglycerin. Archives of Internal Medicine 1980;140(8):1118‐1120. [MEDLINE: ] - PubMed
Reynolds 1989 {published data only}
    1. Reynolds JC, Parkman HP. Achalasia. Gastroenterology Clinics of North America. 1989;18(2):223‐55. - PubMed
Rozen 1982a {published data only}
    1. Rozen P, Gelfond M, Zaltzman S, Baron J, Gilat T. Dynamic, diagnostic, and pharmacological radionuclide studies of the esophagus in achalasia. Radiology 1982;144(3):587‐590. [MEDLINE: ] - PubMed
Rozen 1982b {published data only}
    1. Rozen P, Gelfond M, Salzman S, Baron J, Gilat T. Radionuclide confirmation of the therapeutic value of isosorbide dinitrate in relieving the dysphagia in achalasia. Journal of Clinical Gastroenterology 1982;4(1):17‐22. [MEDLINE: ] - PubMed
Schroeder 1985 {published data only}
    1. Schroeder JS. Combination therapy with isosorbide dinitrate: current status and the future. American Heart Journal. 1985;110(1 Pt 2):284‐91. - PubMed
Stanley 1955 {published data only}
    1. Stanley H, Lorber SM, Shay H. Roentgen studies of esophageal transport in patients with dysphagia due to abnormal motor function. Gastroenterology 1955;28:697‐714. - PubMed
Storr 1999 {published data only}
    1. Storr M, Allescher HD. Esophageal pharmacology and treatment of primary motility disorders. Diseases of the Esophagus. 1999;12(4):241‐57. - PubMed
Swamy 1977 {published data only}
    1. Swamy N. Esophageal spasm: clinical and manometric response to nitroglycerine and long acting nitrites. Gastroenterology 1977;72(1):23‐7. [MEDLINE: ] - PubMed
Tack 1991 {published data only}
    1. Tack J, Janssens J, Vantrappen G. Non‐surgical treatment of achalasia. Hepato‐Gastroenterology. 1991;38(6):493‐7. - PubMed
Traube 1985 {published data only}
    1. Traube M, McCallum RW. Primary oesophageal motility disorders. Current therapeutic concepts. Drugs 1985;30(1):66‐77. - PubMed
Vaezi 1998 {published data only}
    1. Vaezi MF, Richter JE. Achalasia: diagnosis and management. Seminars in Gastrointestinal Disease 1999;10(3):103‐12. - PubMed
Wang 1988 {published data only}
    1. Wang SY, Wu TY, Dai XZ, Wang G, Zhu GH. [Radionuclide esophagography observation on the effect of nitrates in achalasia of the cardia]. Chung‐Hua i Hsueh Tsa Chih [Chinese Medical Journal] 1988;68(7):378‐9. [MEDLINE: ] - PubMed

Additional references

Earlam 1969
    1. Earlam RJ, Ellis FH Jr, Nobrega FT. Achalasia of the esophagus in a small urban community. Mayo Clinic Proceedings 1969;44:478‐83. - PubMed
Field 1944
    1. Field CE, Lond MD. Octyl Nitrate in Achalasia of the Cardia. Lancet 1944;2:848‐51.
Higgins 2008
    1. Higgins JPT, Green S (editors). Cochrane handbook for systematic reviews of interventions. John Wiley & Sons Ltd, 2008.
Howard 1992
    1. Howard PJ. Maher L, Pryde A, et al. Five year prospective study of the incidence, clinical features, and diagnosis of achalasia in Edinburgh. Gut 1992;33:1011‐5. - PMC - PubMed
Katsuki 1977
    1. Katsuki S, Arnold W, Mittal C, Murad F. Stimulation of guanylase cyclase by sodium nitroprusside, nitroglycerin, and nitric oxide in various tissue preparations and comparison to the effects of Na azide and hydroxylamine. Journal of Cyclic Nucleotide Research 1977;3:23‐35. - PubMed
Mayberry 1985
    1. Mayberry JF, Atkinson M. Studies of incidence and prevalence of achalasia in the Nottingham area. Quarterly Journal of Medicine 1985;56:451‐456. - PubMed
Mayberry 1987
    1. Mayberry JF, Atkinson M. Variations in the prevalence of achalasia in Great Britain and Ireland: an epidemiological study based on hospital admissions. Quarterly Journal of Medicine 1987;62:67‐74. - PubMed
Ritvo 1940
    1. Ritvo M, McDonald EJ. Value of nitrates in cardiospasm (achalasia of esophagus): preliminary report. American Journal of Roentgenology 1940;43:500‐8.
Tottrup 1991
    1. Tottrup A, Svane D, Forman A. Nitric oxide mediating NANC inhibition in opossum lower esophageal sphincter. American Journal of Physiology 1991;260:G385‐G389. - PubMed

Publication types

MeSH terms

LinkOut - more resources