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Transcutaneous electrical nerve stimulation decreases lower esophageal sphincter pressure in patients with achalasia

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Abstract

Vasoactive intestinal peptide (VIP) is believed to be an inhibitory neurotransmitter responsible for lower esophageal sphincter (LES) relaxation. In patients with achalasia the concentration of VIP and the number of VIP-containing nerve fibers are reduced or absent. It has been suggested that the response to low-frequency transcutaneous electrical nerve stimulation (TENS) may be medicated be a nonadrenergic noncholinergic pathway in which the release of VIP is responsible for the smooth muscle relaxation. The present study was designed to evaluate the effect of TENS on LES pressure and on VIP plasma concentrations in six patients with achalasia (five female, one male). TENS was performed daily during one week for 45-min sessions with a pocket stimulator that delivered low-frequency pulses (6.5 Hz), at 10 pulses/sec of 0.1-msec duration at intensities of 10–20 mA until rhythmic flexion of the fingers was obtained without producing pain. LES pressure and VIP levels were obtained before TENS, after the first 45-min session, and after a week of daily stimulation. After 45-min, TENS produced a significant reduction (P<0.01) in LES resting pressure from the mean value 56±6.4 mm Hg to 42.3 ±6.4 mm Hg; with LES relaxation improvement from 50.6±3% to 63.1 ±3.2% (P<0.01). After one week of daily TENS, an additional reduction in LES resting pressure (40.3±4 mm Hg) was observed (P<0.01). The mean basal values of VIP in five patients showed a significant increase after 45 min of TENS from 19.8±2.1 pg/ml to 25.3 ±2 pg/ml (P<0.02); with a mean increase of 30%. After one week, the mean plasma values (26.3±1.5 pg/ml) remained still significantly increased compared to basal values (P<0.002). In conclusion, in patients with achalasia, TENS decreases LES pressure, improves LES relaxation, and increases the VIP plasma concentration.

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Authors and Affiliations

  1. Gastroenterology Department, Hospital General del Oeste, Policlinica Metropolitana, Urb. Caurimare, Caracas, Venezuela

    Moises Guelrud MD, Alicia Rossiter MD, Paul F. Souney MS & Maryselis Sulbaran MD

  2. Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, Massachusetts

    Moises Guelrud MD, Alicia Rossiter MD, Paul F. Souney MS & Maryselis Sulbaran MD

  3. Pharmacy Department, Brigham and Women's Hospital, Boston, Massachusetts

    Moises Guelrud MD, Alicia Rossiter MD, Paul F. Souney MS & Maryselis Sulbaran MD

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  1. Moises Guelrud MD
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  2. Alicia Rossiter MD
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  3. Paul F. Souney MS
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  4. Maryselis Sulbaran MD
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Guelrud, M., Rossiter, A., Souney, P.F. et al. Transcutaneous electrical nerve stimulation decreases lower esophageal sphincter pressure in patients with achalasia. Digest Dis Sci 36, 1029–1033 (1991). https://doi.org/10.1007/BF01297442

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  • DOI: https://doi.org/10.1007/BF01297442

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