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April 12, 1985

Effects of Nifedipine in Achalasia and Patients With High-Amplitude Peristaltic Esophageal Contractions

JAMA. 1985;253(14):2046. doi:10.1001/jama.1985.03350380062018

To the Editor.—  In the Oct 5 issue of The Journal, Traube et al1 reported the effects of nifedipine on esophageal motility in achalasia and in nutcracker esophagus. A decrease in lower esophageal sphincter (LES) pressure was noted in both disorders. However, nifedipine also decreased contraction amplitude of the esophageal body in nutcracker esophagus, but not in achalasia.We have recently evaluated 14 patients with classic achalasia before and after the administration of nifedipine (20 mg, sublingually). We observed a decrease in LES pressure (basal pressure, 26.5 ±8.7 mm Hg) of 16%, 35%, and 40% at 15, 30, and 45 minutes, respectively, after the administration of the drug. There were no significant changes in contraction amplitude in the body of the esophagus. These observations are similar to those reported by Traube et al.Why did nifedipine decrease the body contractions in nutcracker esophagus but not in achalasia? In achalasia,