Effect of Cisapride on Relapse of Reflux Oesophagitis, Healed with an Antisecretory Drug

Tytgat, G. N. J.; Hansen, O. J. Anker; Carling, L; Groot, Gerrit H. de; Geldof, Han; Glise, Hans; Efskind, P S; Elsborg, L; Karvonen, Anna‐Liisa; Ohlin, Bo

doi:10.3109/00365529208999945

Cited by 60 publications

(25 citation statements)

References 12 publications

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“…This finding is in agreement with other reports (20), but was not evident as a factor affecting the symptomatic relapse rate in our study. The rate of endoscopic relapse was similar for males and females in all treatment groups.…”

Section: Discussionsupporting

confidence: 83%

See 1 more Smart Citation

Prevention of Relapse in Reflux Esophagitis: A Placebo Controlled Study of Ranitidine 150 mg BID and 300 mg BID

Hegarty

Halvorsen

Hazenberg

et al. 1997

Canadian Journal of Gastroenterology

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OBJECTIVE:To compare the efficacy and safety of long term use of ranitidine 150 mg bid, 300 mg bid and placebo in prevention of endoscopic and symptomatic relapse of reflux esophagitis in an international, doubleblind, placebo controlled, parallel group study. PATIENTS AND METHODS: A total of 279 patients at least 18 years old from hospital out-patient departments with healed esophagitis (grade 0) with no or mild symptoms entered the study. Patients were randomly allocated to receive ranitidine 150 mg, 300 mg or placebo twice daily for 48 weeks. Patients returned for symptom assessments at eight-week intervals and for re-endoscopy every 16 weeks. RESULTS: Both ranitidine regimens were significantly more effective than placebo in preventing endoscopic and symptomatic relapse of reflux esophagitis (P=0.003 for ranitidine 150 mg bid; P<0.001 for ranitidine 300 mg bid). No statistically significant differences were observed in relapse rates between the two ranitidine regimens. The percentage of patients with endoscopic relapse (grade 2) after 48 weeks were 60%, 37% and 27% for placebo, ranitidine 150 mg bid and ranitidine 300 mg bid, respectively (P=0.002 for ranitidine 150 mg bid versus placebo; P<0.001 for ranitidine 300 mg bid versus placebo). Ranitidine was well tolerated. CONCLUSIONS: Ranitidine 150 mg bid and 300 mg bid are safe and effective treatments in the prevention of reflux esophagitis relapse. PATIENTS ET MÉTHODES :En tout, 279 patients d'au moins 18 ans provenant de services externes hospitaliers et ayant une oesophagite cicatrisée (degré 0) avec symptômes nuls ou légers ont participé à l'étude. Les patients ont été assignés aléatoirement à la ranitidine 150 mg ou 300 mg ou à un placebo à prendre deux fois par jour pendant 48 semaines. Les patients ont fait évaluer leurs symptômes à des intervalles de huit semaines et ont subi une endoscopie toutes les 16 semaines. RÉSULTATS : Les deux schémas de ranitidine ont été significativement plus efficaces que le placebo à prévenir les récurrences endoscopiques et symptomatiques de l'oesophagite de reflux (P = 0,003 pour la ranitidine 150 mg b.i.d., P < 0,001 pour la ranitidine 300 mg b.i.d.). Aucune diffé-rence statistiquement significative n'a été observée quant aux taux de ré-currence entre les deux schémas de la ranitidine. Les pourcentages de patients présentant une récurrence endoscopique (grade II) après 48 semaines ont été de 60 %, 37 % et 27 % pour le placebo, la ranitidine 150 mg b.i.d et la ranitidine 300 mg b.i.d. respectivement (P = 0,002 pour la ranitidine 150 mg b.i.d vs le placebo; P < 0,001 pour la ranitidine 300 mg b.i.d. vs le placebo). La ranitidine a été bien tolérée. St Vincent's Hospital, Dublin, Eire; Sentralsykehuset i, Rogaland, Stavangar, Norway; Dordrecht, Holland; Klinika Gastroenterologii, AM, Katowice, Poland; Southampton General Hospital, Southampton, United Kingdom; University of Alberta, Calgary, Alberta; Gasthuisberg, Leuven, Belgium; Glaxo Research and Development Limited, Greenford, United Kingdom Correspondence and rep...

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Section: Discussionsupporting

confidence: 83%

“…The lack of an effect of smoking is counter-intuitive but is found in other reports. Smoking has been found to have no effect on relapse of esophagitis following successful treatment with omeprazole (21) or to be associated with a longer period of remission in patients receiving maintenance therapy with cisapride or placebo (20).…”

Section: Discussionmentioning

confidence: 99%

Prevention of Relapse in Reflux Esophagitis: A Placebo Controlled Study of Ranitidine 150 mg BID and 300 mg BID

Hegarty

Halvorsen

Hazenberg

et al. 1997

Canadian Journal of Gastroenterology

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“…A few studies have suggested that relapse is more common in those who are treated with omeprazole, although the exact mechanism remains unclear and there may be confounding factors such as omeprazole only being used in more severe disease. 12,20 It should be noted that proton pump inhibitors have become the treatment of choice in oesophagitis, and so even if the proton pump inhibitor therapy used in this study contributed to the high relapse rate it is simply re¯ecting the relapse rate which will occur in clinical practice. Another reason for treatment failure might be if the drug was not given in an adequate dose and failed to achieve its desired effect.…”

Section: Discussionmentioning

confidence: 99%

“…12±14 In addition, Tytgat et al reported that cisapride reduced any deterioration in quality of life by using a simple visual analogue scale to assess general well-being. 12 A recent combined analysis of two of these studies suggested that cisapride is most effective in patients whose re¯ux symptoms are not refractory to initial treatment with acid-suppressing drugs. 18 This study assessed consecutive patients with a diagnosis of grade II±III oesophagitis who were healed with omeprazole.…”

Section: Discussionmentioning

confidence: 99%

Maintenance therapy with cisapride after healing of erosive oesophagitis: a double‐blind placebo‐controlled trial

McDougall¹,

Watson²,

Collins³

et al. 1997

Aliment Pharmacol Ther

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The relapsing nature of re¯ux oesophagitis has been well documented in a number of short-term follow-up studies 1±3 and it is known that re¯ux symptoms persist in the majority of oesophagitis patients at least 10 years after diagnosis. 4 To date the best results for maintenance therapy after healing of oesophagitis have been achieved with proton pump inhibitors, which have been reported to reduce relapse rates at 1 year to 10± 30%. 3,5,6 However, although proton pump inhibitors are now accepted as the most effective healing therapy for oesophagitis, concerns remain regarding their safety for long-term maintenance therapy. 7±9It has been reported that the lower oesophageal sphincter pressure in oesophagitis patients who relapse is lower than in non-relapsers.10 Cisapride would seem to be an obvious choice for maintenance therapy given that it can improve lower oesophageal sphincter pressure.11 A few studies have shown that cisapride SUMMARYBackground: There are few data on the role of prokinetic agents as maintenance therapy in moderately severe re¯ux oesophagitis despite the high relapse rate of this condition after healing. Aims: To determine whether cisapride is more effective than placebo as maintenance therapy after healing of moderate erosive oesophagitis in two respects: ®rst, in preventing symptomatic relapse and preserving quality of life; and, second, in improving oesophageal motor function. Patients: Forty-two patients whose grade II±III oesophagitis had been healed with omeprazole were randomized to receive either cisapride 20 mg nocte or placebo for 6 months. Oesophageal pH monitoring and manometry were performed before starting maintenance therapy and after 4 weeks, and symptomatic status and quality of life were assessed at weeks 0, 4, 13 and 26.

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“…Previous studies also reporting adverse events of cisapride found diarrhoea to be the most common. Tytgat et al [33] found diarrhoea was reported by 9% of the patients taking cisapride and in another study diarrhoea was reported in 4% of cisapride recipients and in 3% of placebo recipients [34] and in 3–6.5% in large non-comparative studies [35, 36, 37], and in a 12-month study by Blum et al [38] diarrhoea occurred in 11 and 4% of cisapride and placebo recipients respectively (p < 0.05). This increased stool frequency during cisapride treatment is not caused by malabsorption of water, fat or bile acids, but seems to be the consequence of a direct motor effect [39].…”

Section: Discussionmentioning

confidence: 99%

Effect of Cisapride on Gastroduodenal Reflux and Gall Bladder Motility in Patients with Gallstones

Baxter

Maddern

1998

Dig Surg

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The aim of this work was to assess the effect of 10 mg of cisapride twice daily for 1 week on symptoms, gastroduodenal reflux and gall bladder emptying in patients undergoing cholecystectomy. Seventy-seven patients, 29 male and 48 female, underwent a randomized, double-blind, placebo-controlled trial with a 1-week treatment period between studies before cholecystectomy. Fifty-one of these patients were suitable for gall bladder emptying ejection fraction analysis. Gastroduodenal reflux and gall bladder emptying were assessed using Milk ⁹⁹Tc^m DIDA scans. Cisapride did not significantly alter gastroduodenal reflux but gall bladder motility was altered after cisapride treatment (p < 0.05).

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Effect of Cisapride on Relapse of Reflux Oesophagitis, Healed with an Antisecretory Drug

Cited by 60 publications

References 12 publications

Prevention of Relapse in Reflux Esophagitis: A Placebo Controlled Study of Ranitidine 150 mg BID and 300 mg BID

Prevention of Relapse in Reflux Esophagitis: A Placebo Controlled Study of Ranitidine 150 mg BID and 300 mg BID

Maintenance therapy with cisapride after healing of erosive oesophagitis: a double‐blind placebo‐controlled trial

Effect of Cisapride on Gastroduodenal Reflux and Gall Bladder Motility in Patients with Gallstones

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