Long-term efficacy of oral cisapride in symptomatic upper gut dysmotility

Abstract

We conducted a 12-month trial of cisapride (10 mg three times a day) in 21 patients with gastric stasis due to clinically and manometrically diagnosed gastroparesis (N = 9; seven due to diabetes) or chronic intestinal pseudo-obstruction (N = 12). Radionuclide solid-liquid gastric emptying tests were performed at baseline and at the end of the 12-month period. Symptoms were assessed monthly by diary and every three months by the investigators; frequency and severity of symptoms were scored in a standardized manner. For the whole group of 21 patients, gastric emptying of both solids and liquids improved significantly after one year of cisapride (P less than 0.05). Among chronic intestinal pseudoobstruction patients, there was predominantly an improvement in gastric emptying of solids; in contrast, patients with gastroparesis had a greater improvement in liquid emptying. Total symptom score improved significantly in the gastroparesis group (median score: 8 at baseline vs 6 at one year, P less than 0.05) but not in the chronic intestinal pseudoobstruction patients (median score at baseline 10 vs 9 at one year). Similarly, body weight showed a trend towards improvement in the gastroparesis group. No significant side effects were noted. We conclude that during a 12-month open trial, cisapride was effective in improving gastric emptying in patients with gastric stasis and consistently improved symptoms in those with gastroparesis.

Diabetes mellitus and the stomach

“…Cisapride is thought to promote gastric emptying mainly by acting as a partial agonist at 5-hydroxytryptamine 4 receptors in the myenteric plexus and thereby facilitating cholinergic excitatory neurotransmission [142,143]. In uncontrolled singledose investigations in diabetic patients, the agent was found to accelerate emptying [145,153], but the results of studies extending over longer periods of time have been ambiguous [154,155].…”

Effect of rikkunshito, a Japanese herbal medicine, on gastrointestinal symptoms and ghrelin levels in gastric cancer patients after gastrectomy

“…Rikkunshito is composed of over 100 compounds, including 8 major constituents, and a prokinetic action via NG-nitro-L-arginine could be considered as another candidate mechanism for the symptom relief [39,40]. Prokinetic drugs, including erythromycin, cisapride, metoclopramide, and domperidone, may accelerate gastric emptying after gastrectomy and alleviate post-gastrectomy symptoms [40][41][42][43]. In adult patients with diabetic gastroparesis, normalization of electrical activity has been seen after domperidone administration [44].…”

Prokinetics in the Management of Functional Gastrointestinal Disorders

“…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.…”