Effect of Six Weeks of Treatment With Cisapride in Gastroparesis and Intestinal Pseudo obstruction

Camilleri, Michael; Malagelada, Juan R.; Abell, Thomas L.; Brown, Manuel L.; Hench, Victoria S.; Zinsmeister, Alan R.

doi:10.1016/s0016-5085(89)80068-x

Cited by 71 publications

(20 citation statements)

References 12 publications

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“…However, the initial expectation that there would be a close concordance between delay in emptying and the presence of symptoms such as nausea, abdominal discomfort and vomiting [4] has not been substantiated. In contrast, the relationship between gastric emptying and gastrointestinal symptoms is relatively poor [6][7][8][9][18][19][20][21][22], so that up to 50 % of patients with marked delay in gastric emptying have few, or no upper gastrointestinal symptoms (Fig. 2).…”

Section: Gastrointestinal Symptomsmentioning

confidence: 99%

“…The heterogeneous nature of the motor dysfunctions in diabetic gastroparesis implies that it may be impossible to achieve correction of all motor/sensory abnormalities with one agent. The four prokineticdrugs that have been used widely to treat diabetic gastroparesis are metoclopramide [18,52], domperidone [23,53], cisapride [11,19,20,54] and erythromycin [55]. Their pharmacological properties which lead to improvement in gastric emptying are poorly understood, but involve dopamine receptor blockade (domperidone and metoclopramide), stimulation of motilin receptors (erythromycin) and stimulation and blockade of subtypes of 5-hydroxytryptamine receptors (metoclopramide and cisapride) [1].…”

Section: Treatmentmentioning

confidence: 99%

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Disordered gastric motor function in diabetes mellitus

Horowitz

Fraser

1994

Diabetologia

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SummaryThe application of novel investigative techniques has demonstrated that disordered gastric motility occurs frequently in diabetes mellitus. Gastric emptying is abnormal in about 50 % of diabetic patients and delay in gastric emptying of nutrient-containing meals is more common than rapid emptying. The blood glucose concentration influences gastric motility in diabetes. In IDDM patients, gastric emptying is retarded during hyperglycaemia and may be accelerated by hypoglycaemia. Gastroparesis therefore does not necessarily reflect irreversible autonomic neuropathy and blood glucose concentrations must be monitored when gastric motility is evaluated in diabetic patients. There is a poor relationship between gastric emptying and gastrointestinal symptoms and the mechanisms by which abnormal motility causes symptoms are unclear. The introduction of new gastrokinetic drugs has improved therapeutic options for the management of symptomatic patients with gastroparesis considerably. The contribution of disordered gastric emptying to poor glycaemic control is unclear, but the demonstration that the rate of gastric emptying is a major factor in normal blood glucose homeostasis suggests that this is likely to be significant. [Diabetologia (1994) 37: 543-551]

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Section: Gastrointestinal Symptomsmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Disordered gastric motor function in diabetes mellitus

Horowitz

Fraser

1994

Diabetologia

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“…Attempts to normalise the small intestinal dysmotility, thereby improving the pain in patients with CIIP, have met with little success, and in agreement with other findings the use of erythromycin, maxolon, domperidone, cisapride and octreotide have been largely ineffective (Dyer et al 1969;Lipton & Knauer, 1977;Camilleri et al 1986Camilleri et al , 1989Verne et al 1995;Mann et al 1997). The exception relates to patients with CIPP with associated mixed connective tissue disorders and thyroid disease.…”

Section: Painmentioning

confidence: 89%

Chronic idiopathic intestinal pseudo-obstruction: the need for a multidisciplinary approach to management

Silk

2004

Proc. Nutr. Soc.

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At the outset of the research programme into irritable bowel syndrome (IBS) it was perceived that there was a need to develop a symptom-based classification for the patients. Four groups of patients were identified, those with spastic colon syndrome, diarrhoea-predominant spastic colon syndrome, functional diarrhoea and midgut dysmotility. While working with outpatients with IBS it was noted how some of them had suffered symptoms for many years; specifically, a group of patients satisfying the criteria for midgut dysmotility had also suffered from particularly severe and intractable intestinal symptoms. These patients underwent 24 h ambulatory studies of small intestinal motility and the majority were found to have manometric features of chronic idiopathic intestinal pseudo-obstruction (CIIP). To characterise the cause, laparoscopic full-thickness small intestine and colonic biopsies have been obtained in forty-five of the latter group of patients. Of these patients 58% have been found to have complete or partial deficiency of a-actin epitope staining in the inner circular layer of small intestinal smooth muscle. This deficiency is believed to represent an important biomarker rather than the cause of CIIP, since a-actin epitope deficiency has been observed in association with enteric neuropathy and myopathies. In relation to the management of CIIP patients, a multidisciplinary model is proposed incorporating management of co-morbid psychological and psychiatric pathology, abdominal and musculoskeletal pain, fatigue, urological symptoms and nutrition. A six-stage nutritional management plan for these patients is presented.Chronic idiopathic intestinal pseudo-obstruction: Irritable bowel syndrome:Symptom-based classification: Multidisciplinary management model: Nutritional management plan

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“…In clinical trials cisapride demonstrated benefit (not always consistent) in both the short-and long-term therapy of gastroparesis and dyspepsia. 18,19 However, all of this promise came to naught when reports of serious cardiac arrhythmias, related to QT interval prolongation 20,21 began to appear. The withdrawal of cisapride spurred interest in the development of alternative 5-HT 4 agonists.…”

Section: Serotonergic Agonistsmentioning

confidence: 99%

Prokinetics in the Management of Functional Gastrointestinal Disorders

Quigley

2017

Curr Gastroenterol Rep

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A variety of common and some not common gastrointestinal syndromes are thought to be based on impaired gut motility. For some, the role of motility is well defined, for others and the functional gastrointestinal disorders, in particular, the role of hypo-or dysmotility remains unclear. Over the years pharmacological and physiological laboratories have developed drugs which stimulate gut motility; many have been evaluated in motility and functional disorders with what can best be described as mixed results. Lack of receptor specificity and resultant expected and unexpected adverse events have led to the demise of some of these agents. Newer, more selective agents offer promise but the heterogeneity of the clinical disorders they target continues to pose a formidable challenge to drug development in this area.

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Effect of Six Weeks of Treatment With Cisapride in Gastroparesis and Intestinal Pseudo obstruction

Cited by 71 publications

References 12 publications

Disordered gastric motor function in diabetes mellitus

Disordered gastric motor function in diabetes mellitus

Chronic idiopathic intestinal pseudo-obstruction: the need for a multidisciplinary approach to management

Prokinetics in the Management of Functional Gastrointestinal Disorders

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