Efficacy of Hot Water Drinking Combined with Isosorbide Dinitrate Therapy in Achalasia

  Objective  To evaluate the efficacy of hot water drinking, isosorbide dinitrate and combination of both in achalasia.

  Methods  The patients with untreated achalasia admitted to Peking Union Medical College Hospital in the period of October 2012 to May 2013 were enrolled and randomly divided into group A (hot water drinking and combined therapy) and group B (isosorbide dinitrate and combined therapy). Patients in group A received hot water drinking only during the first week, then combined with isosorbide dinitrate from the second to the fourth week. Patients in group B received isosorbide dinitrate only during the first week, then combined with hot water drinking from the second to the fourth week. Clinical symptoms were evaluated at baseline(2 weeks before treatment) as well as after 1-week and 4-week treatment. High-resolution manometry and X-ray barium esophagram were evaluated at both baseline and after 4-week treatment.

  Results  A total of 41 patients were included in this study, 19 in group A and 22 in group B. There was no significant difference in gender, age and course of disease between the two groups (P>0.05). Compared with baseline, symptoms were significantly alleviated after 1-week treatment and after 4-week treatment in group A (P < 0.05), and symptoms were significantly mitigated after 4-week treatment than after 1-week treatment (P < 0.05). Compared with baseline, symptoms were significantly alleviated after 4-week treatment in group B (P < 0.05). There was no difference in scales of symptoms between the two groups (P > 0.05). Compared with baseline, there was no significant reduction in lower esophageal sphincter pressure (LESP) and integrated relaxation pressure (IRP) after 4-week treatment in both groups (P > 0.05). However, at both baseline and after 4-week treatment, LESP and IRP were significantly decreased after hot water drinking or sublingual isosorbide dinitrate compared with pre-intervention levels in both groups (P < 0.05). There was no change in the width of the esophagus after 4-week treatment in both groups(P > 0.05).

  Conclusions  Hot water drinking or sublingual isosorbide dinitrate could alleviate clinical symptoms by temporarily decreasing LESP and IPR, which could be amplified by the combination of these two treatments, but the effect is not sustained. Hot water drinking combined with sublingual isosorbide dinitrate provides an option of conservative therapy for those intolerant to or relapsing after invasive treatment.