title: Topical bethanechol for the improvement of esophageal dysmotility: a pilot study.
abstract: OBJECTIVE
  We studied a case series to evaluate the effect of topical bethanechol chloride on esophageal function in individuals with ineffective esophageal motility.
  
  
  METHODS
  Five subjects with ineffective esophageal motility underwent high resolution esophageal manometry. Ten 5 mL liquid swallows were performed to establish a baseline. Five milligrams of topical bethanechol was then administered. After 10 minutes, the subjects completed 10 additional liquid swallows. This procedure was repeated with 10 mg of bethanechol in 4 subjects.
  
  
  RESULTS
  After administration of 5 mg of topical bethanechol, the mean (+/- SD) distal contractile integral, an index of esophageal contractility, increased from 178.3 +/- 83.1 mm Hg x s x cm to 272.3 +/- 216.9 mm Hg x s x cm (p = 0.69). The percentage of failed swallows decreased from 52.8% +/- 33.2% to 29.4% +/- 18.3% (p = 0.14). The percentage of peristaltic swallows increased from 28.0% +/- 26.8% to 67.2% +/- 15.3% (p = 0.04). The contractile front velocity was essentially unchanged. After administration of 10 mg of bethanechol,the distal contractile integral decreased from 349.3 +/- 371.0 mm Hg x s x cm to 261.8 +/- 293.5 mm Hg x s x cm (p = 0.72). The percentage of failed swallows increased from 57.5% +/- 37.7% to 66.8% +/- 24.9% (p = 0.46). The percentage of peristaltic swallows increased from 17.5% +/- 23.6% to 28.3% +/- 19.1% (p = 0.29). The contractile front velocity decreased from 11.6 +/- 5.2 cm/s to 4.9 +/- 3.0 cm/s (p = 0.32). No adverse side effects occurred.
  
  
  CONCLUSIONS
  The results of this pilot study support the need for further investigation with larger sample sizes and dose escalation.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Center for Voice, Airway and Swallowing Disorders, Georgia Regents University, Augusta, Georgia, USA.
authors.forename: Ashli
authors.initials: A
authors.lastname: O'Rourke
authors.forename: Paul
authors.initials: P
authors.lastname: Weinberger
authors.forename: Michele
authors.initials: M
authors.lastname: Morrison
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Conklin
authors.forename: Gregory
authors.initials: G
authors.lastname: Postma
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D018723:Bethanechol / Q000008:administration & dosage*; D015331:Cohort Studies; D015154:Esophageal Motility Disorders / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D018721:Muscarinic Agonists / Q000008:administration & dosage*; D010528:Peristalsis / Q000502:physiology; D010865:Pilot Projects; D016896:Treatment Outcome
chemical_list: D018721:Muscarinic Agonists; D018723:Bethanechol