Article Text
Abstract
BACKGROUND Atropine, an anticholinergic agent with central and peripheral actions, reduces gastro-oesophageal reflux (GOR) in normal subjects and patients with gastro-oesophageal reflux disease (GORD) by inhibiting the frequency of transient lower oesophageal sphincter relaxation (TLOSR).
AIMS To compare the effect of methscopolamine bromide (MSB), a peripherally acting anticholinergic agent, with atropine on the rate and mechanism of GOR in patients with GORD.
METHODS Oesophageal motility and pH were recorded for 120 minutes in 10 patients with GORD who were studied on three separate occasions. For the first two recording periods, either atropine (15 μg/kg bolus, 4 μg/kg/h infusion) or saline were infused intravenously. MSB (5 mg orally, four times daily) was given for three days prior to the third recording period.
RESULTS Atropine significantly reduced basal LOS pressure (12.6 (0.17) mm Hg to 7.9 (0.17) mm Hg), and the number of TLOSR (8.1 (0.56) to 2.8 (0.55)) and reflux episodes (7.0 (0.63) to 2.0 (0.43)) (p<0.005 for all comparisons). MSB reduced basal LOS pressure (12.6 (0.17) to 8.7 (0.15) mm Hg, p<0.005), but had no effect on the frequency of TLOSR (8.1 (0.56) to 7.5 (0.59)) and reflux episodes (7.0 (0.63) to 4.9 (0.60)) (p>0.05).
CONCLUSION In contrast to atropine, MSB has no effect on the rate of TLOSR or GOR in patients with GORD. Atropine induced inhibition of TLOSR and GOR is most likely mediated through a central cholinergic blockade.
- gastro-oesophageal reflux
- cholinergic blockade
- transient lower oesophageal sphincter relaxation
Abbreviations
- GOR
- gastro-oesophageal reflux
- GORD
- gastro-oesophageal reflux disease
- LOS
- lower oesophageal sphincter
- MSB
- methscopolamine bromide
- TLOSR
- transient lower oesophageal sphincter relaxation
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Abbreviations
- GOR
- gastro-oesophageal reflux
- GORD
- gastro-oesophageal reflux disease
- LOS
- lower oesophageal sphincter
- MSB
- methscopolamine bromide
- TLOSR
- transient lower oesophageal sphincter relaxation