Table 3. Characteristics of studies evaluating the use of nitrates in achalasia.
| Study | Design | Sample size (n) | Previous achalasia treatment (n, %) | Drug (+/−formulation) | Significant reduction in LOS pressure | Symptomatic improvement (n, %) | Effect on pain |
Side effects (n, %) |
Intolerable side effects (n, %) | Follow-up |
|---|---|---|---|---|---|---|---|---|---|---|
| Gelfond 198117 | Clinical trial | 24 | 8 (33) | ISDN SL | Yes (65.9%) | 19 (79) | NR | 8 (33) | 0 (0) | 2–19 months |
| Gelfond 198212 | RCT | 15 | 3 (20) | ISDN SL | Yes (63.5%) | 13 (87) | NR | 6 (40) | 2 (13) | 5–14 months |
| Ghosh 199413 | RCS | 30† | NR | ISDN SL | NR | Unclear‡ | NR | NR | NR | N/A |
| Rozen 198218 | Clinical trial | 15 | 3 (20) | ISDN SL | Yes (49.6%) | 9 (60) | NR | 2 (13) | 2 (13) | 12 months (mean) |
| Wong 198719 | RCT | 15 | 0 (0) | Nitroglycerin SL | Yes | NR | NR | NR | NR | 30 minutes |
ISDN, isosorbide dinitrate; LOS, lower esophageal sphincter; N/A, not applicable; NR, not reported; RCS, retrospective case series; RCT, randomized controlled trial; SL, sublingual.
†Five patients received nitrates. The study retrospectively examined 30 patients who had undergone pneumatic balloon dilatation.
‡Of group two patients (24–65 years old), five responded to pharmacological treatment, but it is not stated whether this was after nitrates or nifedipine. No patients >65 years old responded to pharmacological treatment. All patients required pneumatic dilatation.