BOG Update

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Discussion

Diltiazem is a non-dihydropyridine (nonDHP) calcium channel blocker (CCB) that affects both vascular smooth muscle and cardiac muscle function, and it has been shown to be an effective treatment for certain cardiovascular diseases. Typically, CCBs are avoided in patients with reflux to prevent worsening of reflux symptoms. Its effect on esophageal motility and lower esophageal sphincter (LES) pressure have been recognized for some time.2 One study showed that DHP CCBs were associated with a 2.7-fold increase in reflux symptoms compared to non-DHP CCBs.3 Moreover, onset of new reflux symptoms and symptom exacerbation occurred least with diltiazem. We present, to our knowledge, the first report of chronic cough with HE treated with the CCB diltiazem. Historically, CCBs have been implicated in worsening reflux disease by decreasing LES tone. As a result, chronic cough due to reflux can be exacerbated with CCB use. In cases when chronic cough is accompanied by HE confirmed on HRM, a trial of diltiazem may be considered as a therapeutic option with the least potential for reflux symptom exacerbation.

Reference List

1. Pavord ID, Chung KF. Management of chronic cough. Lancet. 2008;371(9621):1375-1384. 2. Gelfond M, Rozen P, Gilat T. Isosorbide dinitrate and nifedipine treatment of achalasia: a clinical, manometric and radionuclide evaluation.

Gastroenterology. 1982;83(5):963-969. 3. Hughes J, Lockhart J, Joyce A. Do calcium antagonists contribute to gastro-oesophageal reflux disease and concomitant noncardiac chest pain? Br J

Clin Pharmacol. 2007;64(1):83-89.

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