Peppermint oil improves the manometric findings in diffuse esophageal spasm.
BACKGROUND
Diffuse esophageal spasm (DES) is an uncommon condition that results in simultaneous esophageal contractions. Current medical treatment of DES is frequently unsatisfactory. We hypothesized that, as a smooth muscle relaxant, peppermint oil may improve the manometric findings in DES.


METHODS
Eight consecutive patients with chest pain or dysphagia and who were found to have DES were enrolled during their diagnostic esophageal manometry. An eight-channel perfusion manometry system was used. Lower esophageal sphincter pressure and contractions of the esophageal body after 10 wet swallows were assessed before and 10 minutes after the ingestion of a solution containing five drops of peppermint oil in 10 mL of water. Each swallow was assessed for duration (seconds), amplitude (mm Hg), and proportion of simultaneous and multiphasic esophageal contractions.


RESULTS
Lower esophageal sphincter pressures and contractile pressures and durations in both the upper and lower esophagus were no different before and after the peppermint oil. Peppermint oil completely eliminated simultaneous esophageal contractions in all patients (p < 0.01). The number of multiphasic, spontaneous, and missed contractions also improved. Because normal esophageal contractions are characteristically uniform in appearance, variability of esophageal contractions was compared before and after treatment. The variability of amplitude improved from 33.4 +/- 36.7 to 24.9 +/- 11.0 mm Hg (p < 0.05) after the peppermint oil. The variability for duration improved from 2.02 +/- 1.80 to 1.36 +/- 0.72 seconds (p < 0.01). Two of the eight patients had chest pain that resolved after the peppermint oil.


CONCLUSIONS
This data demonstrates that peppermint oil improves the manometric features of DES.
Pimentel
M
M
GI Motility Program, Department of Medicine, Cedars-Sinai Medical Center, CSMC Burns and Allen Research Institute, 8700 Beverly Boulevard, Los Angeles, CA 90048, U.S.A. mark.pementel@cshs.org
Bonorris
G G
GG
Chow
E J
EJ
Lin
H C
HC
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000188:drug therapy; D003680:Deglutition Disorders / Q000188:drug therapy; D015155:Esophageal Spasm, Diffuse / Q000188:drug therapy*; D004943:Esophagogastric Junction / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D036142:Mentha piperita; D008875:Middle Aged; D010276:Parasympatholytics / Q000008:administration & dosage*; D010528:Peristalsis / Q000187:drug effects; D010938:Plant Oils / Q000008:administration & dosage*; D016896:Treatment Outcome
D010276:Parasympatholytics; D010938:Plant Oils; C015424:peppermint oil