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PubMed1982

Double-blind controlled trial of bethanechol and antacid versus placebo and antacid in the treatment of erosive esophagitis.

To determine the value of bethanechol in the treatment of erosive esophagitis, a double-blind study was undertaken in which 28 patients were randomized to either bethanechol and antacid, or placebo and antacid. Patients were evaluated clinically, endoscopically, and by esophageal manometry before and after 8 wk of therapy. After treatment both groups showed significant improvement in heartburn and in healing of esophageal lesions. Patients who received bethanechol plus antacids did not show a greater improvement than patients who received placebo plus antacids in any category, nor did patients in the bethanechol-treated group have a greater incidence of complete healing. In addition, pretreatment mean lower esophageal sphincter pressure was normal in approximately 30% of patients with erosive esophagitis and this finding was associated with a greater chance for complete healing of esophageal lesions. These results fail to show that the addition of bethanechol to an intensive antacid regimen is more effective than the antacid regimen alone in the treatment of erosive esophagitis and that patients with esophagitis and normal lower esophageal sphincter pressures respond more favorably to medical treatment.

Antacids↗
PubMed1978

Response of the rabbit vas deferens in vivo to vasoactive drugs.

We evaluated the smooth muscle response to the systemic administration of various vasoactive drugs and hormones in vivo in the rabbit vas deferens. Norepinephrine, epinephrine, and urecholine caused contractions of the vas deferens that caused it to shorten and thicken. Isuprel inhibited contractions that were initiated by obstruction of the vas deferens. Catecholamine depletion from guanethidine caused dilation of the vas deferens, increased intraluminal pressures spontaneous contractions, and a spermpacked lumen. The vas deferens in the immature rabbit showed normal response to norepinephrine and obstruction. Estrogen administration prevented the normal dilation and increased peristalsis observed with obstruction.

Animals↗
PubMed1978

Urinary bladder smooth-muscle electrical activity: response to atropine and bethanechol.

Fourteen patients with spinal cord injuries and lower motor neuron type neurogenic bladders and 12 patients with upper motor neuron type neurogenic bladders and spinal cord injuries, were evaluated before and after bethanechol or atropine, respectively. They were compared with 5 patients with benign prostatic hypertrophy or bladder tumors but without neurologic disease. Both drugs were found to modify partially smooth-muscle response. The implications of these results are consistent with the production of electrical activity by the smooth-muscle cells of the bladder wall.

Atropine↗
PubMed1981

Effect of bethanechol or vagal nerve stimulation on ileocecal sphincter pressure in the cat.

Ileocecal sphincter pressure was studied in the cat, using an open-tipped perfused catheter system. Ileocecal sphincter pressure was measured under basal conditions and in response to bethanechol or direct vagal nerve electrical stimulation. The pressure was 26.1 +/- 5.0 mmHg basally, and was unaltered by section of either or both cervical vagi (p less than 0.05). Peripheral cervical vagal stimulation gave a 9.1 +/- 1.1 mmHg increase in ileocecal sphincter pressure (p less than 0.05) but central stimulation had no effect on ileocecal sphincter pressure. The ileocecal sphincter response to peripheral vagal nerve stimulation was antagonized completely by propranolol or phentolamine. Bethanechol gave a dose-response increase in ileocecal sphincter pressure with a maximal response of 18.0 +/- 2.9 mmHg at 50.0 microgram/kg (p less than 0.01). The ileocecal sphincter relaxed with ileal distension and contracted with colonic distension. These studies indicate that (a) the ileocecal sphincter shows an excitatory response to vagal stimulation and cholinergic agonists; (b) basal ileocecal sphincter pressure is independent of the vagi; (c) ileocecal sphincter inhibition can be initiated by ileal distension but not by vagal stimulation.

Animals↗
PubMed1981

Influence of castration upon the seminal vesicle response to parasympathomimetic drugs.

The influence of castration upon rat seminal vesicle responses to acetylcholine, carbachol and betanechol has been investigated through the determination of the parameters pD2 (the apparent affinity constant), alpha (the intrinsic activity) and rho (the relative responsiveness) of such drugs on vesicles excised from normal and castrated rats. The pD2 and alpha values for carbachol and betanechol and the pD2 value for acetylcholine increased after orchiectomy; the pD2 increase was greater for the first two drugs than for acetylcholine. No significant difference in the values of rho of the acetylcholine receptor system was obtained after castration. Since carbachol and betanechol are not metabolized by cholinesterase, these results may indicate that the reported change in cholinesterase activity following castration is not the only factor to be considered as responsible for the variation in the seminal vesicle pharmacological reactivity. These results suggest that additional experimentation may be necessary to clarify the mode of action of these drugs in this system.

Acetylcholine↗
PubMed1981

Cholinergic effects on esophageal transit and clearance.

Modern manometric and scintigraphic techniques were employed in an effort to determine the relationships between esophageal contractions and esophageal transit and clearance. The effects of direct cholinergic stimulation with bethanechol and blockade with atropine were evaluated in a total of 20 normal subjects and 13 patients with symptomatic gastroesophageal reflux. Bethanechol increased the amplitudes of deglutition-induced and distention-induced esophageal contractions, but diminished their propagation velocities. Both esophageal transit and clearance were decreased in patients with reflux, but both were improved after bethanechol. Atropine sulfate decreased the amplitudes of contractions, accelerated their propagation velocities, and delayed esophageal transit and clearance. Both transit and clearance were diminished significantly when reflux patients were compared with normal subjects. The amplitudes of esophageal contraction were significantly lower in patients with reflux than in normal subjects. Neither bethanechol nor atropine affected the incidence of deglutition-induced esophageal contractions. These studies suggest that the efficiency of esophageal emptying may be determined by the amplitudes of esophageal contractions.

Adult↗
PubMed1981

[Effect of nifedipine on canine LESP (author's transl)].

Nifedipine acts on smooth muscle cells to prevent the influx of calcium ions. The present study was undertaken to see whether a relaxatory effect of nifedipine is present on esophageal smooth muscle as well as on vascular smooth muscle. The experiment was performed on anesthetized dog's lower esophageal sphincter pressure (LESP). Nifedipine (0.5 mg/kg) administered sublingually caused rapid and marked depression of LESP. LESP response to either ACO-tetragastrin (0.5 microgram/kg) or bethanechol (5 microgram/kg) was inhibited partially but markedly. This inhibition might be caused by prevention of calcium-ion influx. This depressant effect of nifedipine on LESP both in resting state and in stimulated state is able to apply to therapy of hypermotile disorders of the esophagus.

Animals↗
PubMed1981

Barrett's esophagus: an old entity rediscovered.

I have reviewed Barrett's esophagus in the light of recent advances. Barrett's esophagus is not as rare as general practitioners and gastroenterologists think. Present evidence suggests that the disorder is acquired as a complication of reflux esophagitis. The epithelium is prone to inflammation, ulceration, bleeding, stricture, and adenocarcinoma. The epithelium may contain chief and/or oxyntic cells; pepsinogens are demonstrable by agar gel electrophoresis in the mucosa and Barrett's epithelium secretes pepsin and acid, and also contains gastrin by radioimmunoassay. Pertechnetate scintigraphy in the screening of these patients may be helpful. In the treatment of these patients, anti-reflux operations stop the progressive ascent of the heterotopic epithelium, prevent inflammation, and stricture formation, and lead to healing of the mucosa. Cimetidine and bethanechol along with the conventional medical regimen for reflux esophagitis may also be helpful in healing the inflamed mucosa. Adenocarcinoma in Barrett's epithelium may have a better prognosis than gastric carcinoma which invade the esophagus or than esophageal carcinoma.

Adenocarcinoma↗
PubMed1980

Gastric motor abnormalities in diabetic and postvagotomy gastroparesis: effect of metoclopramide and bethanechol.

Gastroparesis is a relatively uncommon but clinically troublesome disorder that develops in some patients with diabetes mellitus or after gastric operations. Its pathogenesis remains obscure. We used a manometric technique to record pressure changes in fasting patients in the gastric fundus, distal stomach, and adjacent small bowel of patients with severe gastroparesis, asymptomatic diabetic patients, asymptomatic postsurgical patients, and healthy controls. Patients with gastroparesis had normal interdigestive motor cycles (phase III) in the intestine but not in the stomach. Sporadic motor activity in the stomach (phase II) also was markedly reduced. Metoclopramide and bethanecol significantly increased gastric motor activity in these patients, often triggering an intense burst of motor activity in the stomach, similar to phase III. These observations suggest that gastroparesis is a potentially reversible disorder and should encourage further attmpts for pharmacologic control of the syndrome.

Adult↗
PubMed1980

Dyspepsia, antral motor dysfunction, and gastric stasis of solids.

Extensive gastric manometric and emptying studies were performed in a patient with postprandial dyspeptic symptoms which, for many years, had been diagnosed as functional complaints. After ingestion of a mixed, solid-liquid meal we observed marked gastric stasis of solids associated with a weak antral pressure response, whereas gastric emptying of fluids was normal. Fundic pressure activity, recorded separately, was also normal. This case may represent a pathophysiologic expression of the specific roles of the antrum in the emptying of solids (abnormal) and of the fundus in the emptying of liquids (normal) and shows that pathophysiologic abnormalities can sometimes be demonstrated in patients lumped under a "functional" category.

Aged↗
PubMed1980

Pathogenesis of diabetic gastroparesis: a pharmacologic study.

The motor function of the antrum was studied in 7 normal subjects, 4 patients with diabetes without GI symptoms, and 7 patients with diabetic gastroparesis. Both the number of antral contractions and the cumulative antral activity (percent of time during which the antrum contracted) in patients with diabetic gastroparesis were significantly lower than in normal subjects and diabetic patients without gastroparesis (P less than 0.01). Interdigestive motor complexes were observed in all normal subjects, but they were not present in any patients with diabetic gastroparesis. Intravenous metoclopramide did not affect the rate of antral contractions (P less than 0.1), but it increased the cumulative antral activity (P less than 0.001) in normal subjects and diabetics without gastroparesis. Metoclopramide, however, did not alter the rate of antral contractions (P less than 0.09) or the total cumulative antral activity (P less than 0.09) in diabetic patients with gastroparesis. Furthermore, in normal subjects, the action of metoclopramide was blocked by atropine sulfate (P less than 0.003). Bethanechol caused a slight increase in the number of antral contractions (P less than 0.05) and cumulative antral activity (P less than 0.01) in normal subjects. This cholinergic drug caused a marked increase in the rate of antral contractions and the cumulative antral activity in diabetic patients with gastroparesis. Antral contractions and cumulative antral activity were restored by bethanechol to normal values. These findings suggest a variable degree of gastric neuropathy in individual patients with diabetic gastroparesis with functionally intact antral muscles as assessed by their pharmacologic response to cholinergic stimulation.

Adult↗