Evaluation of oral cisapride and metoclopramide in diabetic autonomic neuropathy: an eight‐week double‐blind crossover study

Caestecker, John S. de; Ewing, D J; Tothill, P.; Clarke, B F; Heading, R. C.

doi:10.1111/j.1365-2036.1989.tb00192.x

Cited by 41 publications

(10 citation statements)

References 28 publications

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“…For example, nausea and vomiting are sporadic in diabetic patients and correlate poorly with the degree of gastric emptying delay in short-and long-term follow-up [12][13][14]. Indeed, many patients with severe delays are asymptomatic, while patients presenting with symptoms often have normal emptying [14,15]. The poor correlation is emphasized further by outcomes from prokinetic medications, such as metoclopramide and domperidone [16,17].…”

Section: Discussionmentioning

confidence: 99%

Tricyclic Antidepressants for Chronic Vomiting in Diabetic Patients

et al. 2006

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Chronic vomiting in diabetic patients often is unresponsive to prokinetic agents and poorly explained by delayed gastric emptying or neuropathy. This retrospective study examines clinical response to tricyclic antidepressants, a treatment of reported benefit in nondiabetic patients with unexplained vomiting syndromes. Outcomes were studied in 24 diabetic outpatients who had been treated with tricyclic antidepressants specifically for nausea and vomiting after an unsatisfactory response to prokinetic therapy. Symptom patterns and treatment response were determined from chart review and telephone interview. Ten patients (42%) had recurrent, stereotypical vomiting episodes with symptom-free intervals suggesting cyclic vomiting syndrome; 14 (58%) had persistent symptoms. By chart review, at least moderate symptom response to tricyclic antidepressant treatment (median dosage, 50 mg/day) occurred in 88% of subjects, with complete or nearly complete resolution of symptoms in one-third. At follow-up interview, 77% self-reported at least moderate symptom improvement during therapy and 68% rated tricyclic antidepressants the most effective treatment received. Duration of diabetes, presence of neuropathy, and psychiatric status were not predictive of treatment outcome in multivariate analysis, but a cyclical symptom pattern attenuated antidepressant response (P< 0.05). In this retrospective review, the majority of diabetic patients with chronic vomiting and incomplete response to prokinetic therapy benefited from tricyclic antidepressants in low-dose, open-label regimens and rated them the most effective treatment received. This therapeutic option should be further studied in diabetic patients considering the morbidity of chronic vomiting in this population.

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Section: Discussionmentioning

confidence: 99%

Tricyclic Antidepressants for Chronic Vomiting in Diabetic Patients

et al. 2006

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“…Furthermore, improvement in gastric emptying does not always equate with symptom relief, although surprisingly few studies have tested this hypothesis. Hyperglycaemia may account for the negative outcome of prokinetic therapy on gastric emptying in diabetes [225,227,251]. A systematic analysis showed that the motilin-agonist erythromycin was superior to domperidone, metoclopramide or cisapride in the acceleration of gastric emptying, while both erythromycin and domperidone appear to relief symptoms the most [252].…”

Section: Prokinetic Drugsmentioning

confidence: 98%

Current Concepts in Gastric Motility in Diabetes Mellitus

Block¹,

Leeuw²,

Pelckmans³

et al. 2006

CDR

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This review addresses the current concepts in our understanding of the epidemiology, mechanisms, symptoms, clinical consequences, diagnosis and treatment of delayed gastric emptying in patients with diabetes. Upper gastrointestinal symptoms, particularly postprandial fullness, nausea, vomiting and abdominal bloating, occur in 30-50% of patients with diabetes. The use of scintigraphic techniques, and more recently breath test, has shown that as many as 50% of diabetic patients have gastroparesis. Diabetic gastroparesis comprises a decrease in fundic and antral motor activity, a reduction or a lack of the interdigestive migrating motor complex, gastric dysrhythmias, and pylorospasms. The mechanisms involved include: autonomic neuropathy, acute hyperglycaemia, and abnormalities in gastrointestinal hormones and neuropeptides. Other possible contributing factors such as hypothyroidism and H. pylori infection are discussed as well. Because treatment is possible by means of dietary advise, prokinetics or surgical procedures, it is important to identify risk factors for and to diagnose gastroparesis to prevent morbidity by controlling gastrointestinal symptoms, and to enhance glucoregulation. Understanding the current advances is key to the development of novel therapeutic strategies and for making rational choices in the management of diabetic gastroparesis.

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“…However, in a double-blind crossover study between metoclopramide and cisapride, there was no significant difference in symptomatic control. There was a trend towards reduced nausea and vomiting with metoclopramide while cisapride showed a trend towards reduced epigastric fullness [54]. Both metoclopramide and cisapride were most effective in reversing the morphine-induced delay in gastric emptying and small intestinal transit in mice compared with domperidone, erythromycin and mosapride [55].…”

Section: Clinical Efficacymentioning

confidence: 99%

Metoclopramide in the treatment of diabetic gastroparesis

Lee¹,

Kuo²

2010

Expert Review of Endocrinology & Metabolism

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Gastroparesis is a chronic disorder that affects a significant subset of the population. Diabetes mellitus is a risk factor for the development of gastroparesis. Currently, metoclopramide is the only US FDA-approved medication for the treatment of gastroparesis. However, the FDA recently placed a black-box warning on metoclopramide because of the risk of related side effects, including tardive dyskinesia, the incidence of which has been cited to be as high as 15% in the literature. This review will investigate the mechanisms by which metoclopramide improves the symptoms of gastroparesis and will focus on the evidence of clinical efficacy supporting metoclopramide use in gastroparesis. Finally, we seek to document the true complication risk from metoclopramide, especially tardive dyskinesia, by reviewing the available evidence in the literature. Potential strategies to mitigate the risk of complications from metoclopramide will also be discussed. Keywords diabetes mellitus; gastroparesis; metoclopramide; tardive dyskinesiaGastroparesis is a chronic disorder characterized by impaired gastric emptying and altered motility in the upper GI tract in the absence of mechanical obstruction. It is estimated to affect approximately 5 million individuals in the USA and is most often seen in young individuals with a mean age of onset of 34 years. There is a large female-to-male predominance (4:1 ratio), and gastroparesis is frequently seen in diabetics [1]. It generally presents with nonspecific symptoms including early satiation, nausea, emesis, bloating, abdominal pain, heartburn, anorexia and weight loss. Gastroparesis is likely a heterogeneous condition with the most common etiologies having been identified as idiopathic (36%) and diabetes mellitus (30%) [2]. Numerous physiological factors may contribute to symptoms such as abnormalities in liquid and solid meal emptying, emptying of indigestible objects (e.g., fiber), and gastric and proximal small bowel contractility.The pathophysiology behind gastroparesis is varied and depends upon the etiology of disease. Vagal and/or autonomic neuropathy [3,4] play an important role in the development of diabetic gastroparesis and it is estimated to occur in up to 20-40% of patients with

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Evaluation of oral cisapride and metoclopramide in diabetic autonomic neuropathy: an eight‐week double‐blind crossover study

Cited by 41 publications

References 28 publications

Tricyclic Antidepressants for Chronic Vomiting in Diabetic Patients

Tricyclic Antidepressants for Chronic Vomiting in Diabetic Patients

Current Concepts in Gastric Motility in Diabetes Mellitus

Metoclopramide in the treatment of diabetic gastroparesis

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