Altered oesophageal motility following the administration of the 5-HT1 agonist, sumatriptan

Authors


Houghton Dr Department of Medicine, University Hospital of South Manchester, Nell Lane, West Didsbury, Manchester M20 2LR, UK. E-mail: lahoughton@man.ac.uk

Abstract

Background

: The 5-HT1 agonist sumatriptan, used in the treatment of migraine, can cause chest pain.

Aim

: To investigate the effect of a therapeutic dose of sumatriptan (6 mg s.c.) on oesophageal motility.

Methods

: In 16 normal healthy subjects aged 19–32 years (9 males), the manometric response of the lower oesophageal sphincter (sleeve sensor), oesophageal body (four sites), stomach and pharynx (to register swallows) to 5 mL water swallows was assessed before and after a subcutaneous injection of either sumatriptan (6 mg) or saline control. Symptoms and ECGs were also monitored.

Results

: Sumatriptan 6 mg s.c. altered oesophageal motility in all subjects. This was reflected by a significant increase in the amplitude of oesophageal body contractions (change from pre- to 1 h post-injection: sumatriptan 9.9 (2.8, 17.1) mmHg vs. placebo – 0.8 (– 4.2, 2.6) mmHg, difference 10.8 (4.4, 17.1) mmHg; P=0.003) and a transient increase in lower oesophageal sphincter pressure (change from pre- to 5 min post-injection: sumatriptan 10.9 (5.2, 16.6) mmHg vs. placebo 5.1 (1.8, 8.4) mmHg, difference 5.8 (– 0.7, 12.3) mmHg; P=0.08). Sumatriptan had no effect on the velocity of propagation of oesophageal contractions (change from pre- to 1 h post-injection: sumatriptan – 0.1 (– 0.3, 0.1) cm/s vs. placebo – 0.1 (– 0.3, 0.0) cm/s, difference 0.1 (– 0.1, 0.2) cm/s; P = 0.40). One subject experienced chest symptoms following sumatriptan and, although motility was altered, this did not reach pathological levels. No ECG abnormalities were observed.

Conclusion

: Sumatriptan (6 mg s.c.) significantly alters oesophageal motor function without affecting the ECG. It is therefore possible that sumatriptan-induced chest symptoms may have an oesophageal origin. The evaluation of similar therapeutic agents for migraine on oesophageal function may be justified.

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