title: Beneficial effect of the 5-HT1A receptor agonist buspirone on esophageal dysfunction associated with systemic sclerosis: A pilot study.
abstract: BACKGROUND
  Esophageal involvement in systemic sclerosis (SSc) carries significant morbidity and is empirically managed with domperidone, albeit with questionable efficacy. The oral 5-HT1A receptor agonist buspirone may enhance esophageal peristalsis and lower esophageal sphincter (LES) function in healthy volunteers.
  
  
  OBJECTIVE
  We aimed to test the hypothesis that buspirone may exert a beneficial acute effect on esophageal motor dysfunction in symptomatic patients with SSc.
  
  
  METHODS
  Twenty consecutive patients with SSc reporting esophageal symptoms underwent high-resolution manometry before and 30 minutes after administration of buspirone (10 mg). Ten other patients received domperidone (10 mg) and served as control group. Changes in LES resting and residual pressure, amplitude, duration, and velocity of distal esophageal body contractions were examined.
  
  
  RESULTS
  Esophageal hypomotility and hypotensive LES was found in 63% and 67% of patients, respectively. Demographic and clinical characteristics, including baseline manometric parameters, were comparable between groups. Resting pressure of LES increased after buspirone from 9.42 ± 2.6 to 11.53 ± 3.4 mmHg (p = 0.0002 by paired t-test), but not after domperidone; a trend for increase of amplitude of contractions was also observed after buspirone (p = 0.09). Comparison of the individual changes revealed that buspirone was superior to domperidone in enhancing LES pressure ( + 2.11 ± 2.0 versus -0.45 ± 2.3 mmHg, p = 0.006). No significant effects of either drug were noted on other examined parameters of esophageal function.
  
  
  CONCLUSIONS
  The beneficial acute effect of buspirone on impaired LES function associated with SSc suggests a role of 5-HT1A receptor-mediated interactions in these patients. Prospective studies to examine whether buspirone is of long-term therapeutic value for SSc-associated esophageal disease are warranted.
authors.affiliation: Academic Department of Gastroenterology, Athens Medical School, "Laiko" GH, Athens, Greece.
authors.forename: George P
authors.initials: GP
authors.lastname: Karamanolis
authors.affiliation: Rheumatology Unit, First Department of Propaedeutic and Internal Medicine, Athens Medical School "Laiko" GH, Athens, Greece.
authors.forename: Stylianos
authors.initials: S
authors.lastname: Panopoulos
authors.affiliation: Academic Department of Gastroenterology, Athens Medical School, "Laiko" GH, Athens, Greece.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Karlaftis
authors.affiliation: Academic Department of Gastroenterology, Athens Medical School, "Laiko" GH, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Denaxas
authors.affiliation: Academic Department of Gastroenterology, Athens Medical School, "Laiko" GH, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kamberoglou
authors.affiliation: Rheumatology Unit, First Department of Propaedeutic and Internal Medicine, Athens Medical School "Laiko" GH, Athens, Greece.
authors.forename: Petros P
authors.initials: PP
authors.lastname: Sfikakis
authors.affiliation: Academic Department of Gastroenterology, Athens Medical School, "Laiko" GH, Athens, Greece.
authors.forename: Spiros D
authors.initials: SD
authors.lastname: Ladas
keywords: Scleroderma; buspirone; domperidone; esophagus; high-resolution manometry