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©2013 UpToDate ® Print Email The cholecystokinin (CCK) octapeptide test for achalasia CCK has a dual effect on the lower esophageal sphincter (LES): it stimulates smooth muscle contraction and the release of inhibitory neurotransmitters. Administration of CCK normally causes the LES pressure to fall because the effect on inhibitory neurotransmitters is greater. In patients with achalasia, CCK causes the LES pressure to rise. Reprinted, courtesy of the Clinical Teaching Project of the American Gastroenterological Association©. This slide cannot be downloaded but may be purchased as part of a set from the AGA through Milner-Fenwick, Inc. at 1-800-432-8433.