The effect of nitroglycerine and long acting
nitrites was studied in a group of 8 normal control subjects and 12 patients with
esophageal spasm. The objective response of the esophagus to these drugs was recorded by obtaining esophageal manometric studies and was correlated with response in clinical symptoms. In 7 patients who had significant
gastroesophageal reflux associated with
spasm, the response to nitroglycerine was unpredictable. But in the group of 5 patients with
diffuse esophageal spasm without
gastroesophageal reflux, the response was uniformly good. All of the patients who responded to nitroglycerine also responded to long acting
nitrites. These 5 patients, who were placed on long term management with long acting
nitrites, remained symptom-free from 6 months to 4 years. None of them had recurrence of symptoms while they were on long acting
nitrite therapy. The study suggests that if
esophageal spasm is associated with reflux, the use of
nitrites is less effective in controlling
spasm than it is in those who do not show this association, and that
diffuse esophageal spasm can be effectively managed with long acting
nitrites on a long term basis in the absence of reflux. If there is
esophageal spasm associated with
reflux esophagitis,
nitrites may be beneficial as an adjunct to antireflux
therapy.