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Theophylline improves esophageal chest pain--a randomized, placebo-controlled study.

Author(s): Rao SS, Mudipalli RS, Remes-Troche JM, Utech CL, Zimmerman B

Affiliation(s): Department of Internal Medicine, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.

Publication date & source: 2007-05, Am J Gastroenterol., 102(5):930-8. Epub 2007 Feb 21.

Publication type: Randomized Controlled Trial; Research Support, N.I.H., Extramural

BACKGROUND, AIM: The treatment of esophageal (noncardiac) chest pain is unsatisfactory and there is no approved therapy. A previous uncontrolled study suggested that theophylline may be useful. Our aims were to investigate the effects of theophylline on esophageal sensorimotor function and chest pain. METHODS: In a double-blind study, sensory and biomechanical properties of the esophagus were assessed using impedance planimetry in 16 patients with esophageal hypersensitivity, after intravenous theophylline or placebo. In a second, randomized 4-wk crossover study, oral theophylline and placebo were administered to 24 patients with esophageal hypersensitivity. Frequency, intensity, and duration of chest pain episodes were evaluated. RESULTS: After IV theophylline, chest pain thresholds (P=0.027) and esophageal cross-sectional area (P=0.03) increased and the esophageal wall became more distensible (P=0.04) compared with placebo. After oral theophylline, the number of painful days (P=0.03) and chest pain episodes (P=0.025), pain duration (P=0.002), and its severity (P=0.031) decreased. Overall symptoms improved in 58% on theophylline and 6% on placebo (P<0.02). There was no order effect. CONCLUSIONS: Theophylline relaxed the esophageal wall, decreased hypersensitivity, and improved chest pain. Theophylline is effective in the treatment of functional chest pain.

Page last updated: 2007-08-04

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