Cisapride increases gallbladder volume in gallstone patients before and after extracorporeal shock wave lithotripsy

Abstract

SUMMARY We have previously shown that oral cisapride causes a dose‐related increase of fasting gallbladder volume in healthy subjects. The present study investigates the effect of cisapride on gallbladder motility in 16 patients with gallbladder stones: 8 patients had no biliary symptoms, but the other 8 patients with symptomatic gallstone disease were studied before and 6 weeks after extracorporeal shock wave lithotripsy (ESWL). For each study the patients received a single oral dose of 20 mg cisapride; fasting gallbladder volume was measured by ultrasound before, and for 120 minutes after, drug administration. In the 8 asymptomatic patients a mean maximal increase of the fasting volume to 152.7 ± 7.6% of the initial value was observed at a mean 97.5 ± 8.3 minutes after cisapride ingestion. Similarly, in the 8 patients with biliary pain mean fasting volume after cisapride ingestion increased to 141.3 ± 5.7% before ESWL treatment and to 145.0 ± 5.8% after ESWL and 6 weeks of oral litholytic therapy. There were no significant differences between the results in the symptomatic and asymptomatic patients. Our results indicate that cisapride increases the gallbladder volume in gallstone patients regardless of biliary symptoms. Similar volume changes were observed before therapy and after ESWL with bile acid therapy. The therapeutic efficacy of litholytic agents could be diminished by simultaneous cisapride administration.

Effectiveness of prokinetic agents against diseases external to the gastrointestinal tract

“…Several researchers also reported improvement of gallbladder motility after cisapride treatment. [73][74][75][76][77][78] Mechanisms via which cisapride may interact with gallbladder function are multiple and include direct effects on gallbladder and the sphincter of Oddi, as well as indirect effects involving gastrointestinal hormone levels, gastric emptying, gallbladder refilling, interdigestive migrating motor cycle, and small intestinal transit. 79 Phamacologically, the direct effects of cisapride on myenteric end neurons should increase fasting gallbladder tone.…”

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“…Consequent to these effects on colonic motor and sensory function, tegaserod is indicated for the treatment of irritable bowel syndrome with constipation in women (reviewed in[ 12 ]). Although functional 5-HT 4 receptors have not been demonstrated in the gallbladder or biliary tract, cisapride, a 5-HT 4 -agonist/5-HT 3 -antagonist, has been variably reported to increase, decrease, and have no effect on gallbladder volume in human subjects[ 13 - 15 ]. Our previous work[ 16 ] with cisapride, in the Richardson ground squirrel model of cholesterol gallstone formation, revealed that this prokinetic agent reversed the defect in gallbladder contractility, enhanced bile salt secretion and so lowered cholesterol saturation.…”