Theophylline improves esophageal chest pain - A randomized, placebo-controlled study

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.