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
Meta-Analysis
. 2023 May 22;23(1):170.
doi: 10.1186/s12876-023-02787-3.

Phosphodiesterase 5 (PDE-5) inhibitors (sildenafil, tadalafil, and vardenafil) effects on esophageal motility: a systematic review

Arman Shafiee  1   2   3 , Razman Arabzadeh Bahri  4 , Mohammad Mobin Teymouri Athar  5 , Fatemeh Afsharrezaei  6 , Mostafa Gholami  4
Affiliations
Meta-Analysis

Phosphodiesterase 5 (PDE-5) inhibitors (sildenafil, tadalafil, and vardenafil) effects on esophageal motility: a systematic review

Arman Shafiee et al. BMC Gastroenterol. .

Abstract

Background: Esophageal motility disorders are a group of disorders associated with dysfunctional swallowing resulting from impaired neuromuscular coordination. Phosphodiesterase 5 (PDE-5) inhibitors induce smooth relaxation and are proposed as a treatment option for esophageal motility disorders such as achalasia.

Methods: This study is conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We systematically searched MEDLINE/ PubMed, Scopus, EMBASE, and Web of Science databases for esophageal outcomes of individuals treated with PDE5 inhibitors. A random effect meta-analysis was conducted.

Results: A total of 14 studies were included. They were conducted in different countries, with Korea and Italy having the highest number of articles. The main drug assessed was sildenafil. PDE-5 inhibitors resulted in a significant reduction in lower esophageal sphincter pressure (SMD - 1.69, 95% CI: -2.39 to -0.99) and the amplitude of contractions (SMD - 2.04, 95% CI: -2.97 to -1.11). Residual pressure was not significantly different between the placebo and sildenafil groups (SMD - 0.24, 95% CI: -1.20 to 0.72). Furthermore, a recent study reported contractile integral, stating that ingestion of sildenafil leads to a significant reduction in distal contractile integral and a significant increase in proximal contractile integral.

Conclusion: PDE-5 inhibitors significantly reduce LES resting pressure and esophageal peristaltic vigor, decreasing esophageal body contractility and contraction reserve. Therefore, using these drugs in patients affected by esophageal motility disorders may potentially improve their condition regarding symptom relief and prevention of further associated complications. Future reports investigating larger sample size is necessary in order to establish definite evidence regarding the efficacy of these drugs.

Keywords: Achalasia; Esophageal motility; Phosphodiesterase; Sildenafil; Tadalafil; Vardenafil.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interest.

Figures

Fig. 1
Fig. 1
Evidence search and selection based on the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) approach
Fig. 2
Fig. 2
Forest plot for the efficacy of phosphodiesterase 5 (PDE-5) inhibitors on lower esophageal sphincter pressure
Fig. 3
Fig. 3
Forest plot for the efficacy of phosphodiesterase 5 (PDE-5) inhibitors on the amplitude of contractions
Fig. 4
Fig. 4
Forest plot for the efficacy of phosphodiesterase 5 (PDE-5) inhibitors on residual pressure
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Müller M, Gockel I. [Esophageal motility disorders] Der Internist. 2015;56(6):615. doi: 10.1007/s00108-014-3603-x. - DOI - PubMed
    1. Schlottmann F, Patti MG. Esophageal achalasia: current diagnosis and treatment. Expert Rev Gastroenterol Hepatol. 2018;12(7):711–21. doi: 10.1080/17474124.2018.1481748. - DOI - PubMed
    1. Hirano I. Pathophysiology of achalasia. Curr Gastroenterol Rep. 1999;1(3):198–202. doi: 10.1007/s11894-999-0034-2. - DOI - PubMed
    1. Savarino E, Bhatia S, Roman S, Sifrim D, Tack J, Thompson SK, et al. Achalasia Nat reviews Disease primers. 2022;8(1):28. doi: 10.1038/s41572-022-00356-8. - DOI - PubMed
    1. Wong MW, Hung JS, Lei WY, Yi CH, Liu TT, Chen CL. Influence of sildenafil on esophageal motor function in humans: studies using high-resolution manometry. Neurogastroenterology and motility: the official journal of the European Gastrointestinal Motility Society. 2020;32(7):e13840. doi: 10.1111/nmo.13840. - DOI - PubMed

MeSH terms

LinkOut - more resources