Therapeutic efficacy of isosorbide dinitrate for dysphagia after endoscopic injection sclerotherapy for varices in cirrhotic patients

Abstract

Background: Isosorbide dinitrate (ID) improves dysphagia of achalasia patients by lowering the low esophageal pressure. Dysphagia occurs in cirrhotic patients undergoing endoscopic injection sclerotherapy (EIS) for esophageal varices even with no structural abnormalities as its sequela. We tested whether ID can be therapeutic for dysphagia of this type.Methods: ID was given for 2–6 weeks to 13 patients with dysphagia lasting for longer than 4 weeks after EIS despite no esophagolumenal stricture on endoscopy and barium swallows. EIS was done three to six times as an injection series of ethanolamine oleate into the varices at intervals of 1–2 weeks until they were obliterated. The therapeutic efficacy of ID was evaluated by symptom severity four‐degree scorings. Esophageal transit time and emptying time were calculated from the time–activity curves on esophageal scintigraphy.Results: At 2 weeks after ID medication, dysphagia was decreased by one score in 12 of 13 patients, and by two scores in one patient. However, dysphagia at the same extent recurred in nine patients within 6 weeks after stopping ID medication, which was improved similarly by remedication. Two patients in whom dysphagia of one and two scores disappeared after ID medication dropped out because of headache. The remaining two patients remained asymptomatic for longer than 6 months after the first medication. Esophageal scintigraphy disclosed the shortening of the emptying time after ID administration in two patients.Conclusions: ID may be effective for relieving functional dysphagia after EIS for esophageal varices in cirrhotic patients.