Cholinergic Therapy of Chronic Heartburn

Oral bethanechol has been shown to produce a sustained rise in lower esophageal sphincter pressure. We studied its effect on 20 patients with chronic heartburn refractory to usual therapy. All patients had a positive Bernstein test and manometric evidence of lower esophageal sphincter incompetence. In a randomized double-blind crossover study, each patient received either 25 mg bethanechol or placebo four times/day for 2 months; after a 2-month rest period the opposite treatment (drug or placebo) was given for 2 months. The patients' symptoms were evaluated each month of the study. Antacid, taken ad lib., was quantitated monthly. The results showed significant (P < 0.05) improvement in heartburn symptoms and decreased antacid use during bethanechol therapy. Bethanechol may be a welcome addition to therapy of refractory heartburn.