Читать книгу The Esophagus - Группа авторов - Страница 45

Outside of antidepressant medications, another potential treatment option for ECP is theophylline, which is an older medication that has been used in asthma for over 70 years. Theophylline functions by inhibiting phosphodiesterases (PDEs), antagonizing adenosine receptors, as well as affecting inflammatory gene expression [98]. Rao et al. administered intravenous theophylline [loading dose = (0.5 L/kg body weight) × (average body weight) × (15 mg/L)] to 21 consecutive patients with functional CP, showing this increased the pain threshold in 76% of patients whose symptoms were reproduced by esophageal balloon distension, as well as improved median threshold pressures for pain and discomfort (p < 0.01) [99]. Eight patients with response to IV theophylline were then treated with oral theophylline (maintenance dose oral 6 mg/kg/day in two divided doses) for three months, seven of whom reported a symptomatic benefit. The results of this study were then followed up with a double‐blind, randomized, placebo‐controlled study that assessed sensory and biomechanical responses to IV theophylline [loading dose = (0.5 L/kg body weight) × (average body weight) × (15 mg/L)] and symptomatic patient responses to oral theophylline 200 mg twice daily after meals [100]. With IV theophylline (n = 16), chest pain thresholds increased (p = 0.027), as did esophageal balloon distensibility thresholds (p = 0.04) [100]. With oral theophylline, reduction in painful days (p = 0.03), chest pain episodes (p = 0.025), pain duration (p = 0.002) and pain severity (p = 0.031) all decreased, with an overall improvement in symptoms in 58% vs. 6% on placebo (p < 0.02) [100].