Erythromycin enhances oesophageal motility in patients with gastro-oesophageal reflux.
BACKGROUND
Intravenous (i.v.) erythromycin enhances gastric emptying and oesophageal motility in both healthy and disease situations, acting either as a motilin or acetylcholine agonist. The purpose of the present paper was to investigate any possible effect of i.v. erythromycin on oesophageal motility in patients with gastro-oesophageal reflux (GOR).


METHODS
In 15 patients with GOR (proven on 24-h ambulatory oesophageal pH measurement), standard oesophageal manometry was performed after i.v. injection of placebo and 200 mg erythromycin, in a random blind fashion.


RESULTS
Erythromycin significantly increased lower oesophageal sphincter (LOS) pressure from 17 +/- 5 to 41 +/- 10 mmHg (P < 0.001), without affecting the postdeglutition relaxation of LOS. Erythromycin also increased the amplitude (from 79 +/- 34 to 97 +/- 40 mmHg; P < 0.001), duration (from 3.4 +/- 0.6 to 3.8 +/- 0.6 s; P = 0.005), velocity (from 3.1 +/- 0.8 to 3.5 +/- 1.15 cm/s; P = 0.0047) and strength (from 149 +/- 84 to 201 +/- 103 mmHg.s; P < 0.001) of peristalsis at 5 cm proximal to the LOS. Similarly, the drug increased the amplitude of peristalsis at 10 and 15 cm proximal to the LOS (from 70 +/- 39 to 77.4 +/- 37 mmHg; P = 0.049 and from 36 +/- 20 to 49 +/- 36 mmHg; P = 0.004, respectively) and the duration of peristalsis at the same levels (from 3.1 +/- 0.6 to 3.3 +/- 0.5 s; P = 0.011, and from 2.7 +/- 0.6 to 3 +/- 0.5 s; P = 0.003, respectively).


CONCLUSIONS
Intravenously administered erythromycin improves impaired oesophageal motility in patients with GOR. This observation might be of clinical use.
Chrysos
E
E
Department of General Surgery, University Hospital of Heraklion, Heraklion, Crete GR-711 10, Greece. chrysos@danae.med.uoc.gr
Tzovaras
G
G
Epanomeritakis
E
E
Tsiaoussis
J
J
Vrachasotakis
N
N
Vassilakis
J S
JS
Xynos
E
E
D000328:Adult; D000368:Aged; D004311:Double-Blind Method; D004917:Erythromycin / Q000008:administration & dosage* / Q000009:adverse effects; D015154:Esophageal Motility Disorders / Q000188:drug therapy*; D004943:Esophagogastric Junction / Q000187:drug effects; D005260:Female; D005745:Gastric Acidity Determination; D005746:Gastric Emptying / Q000187:drug effects*; D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory
D004917:Erythromycin