Measurement of gastric emptying in dyspeptic patients: effect of a new gastrokinetic agent (cisapride).

Abstract

SUMMARY Symptoms suggesting gastroparesis in patients without gastric outlet obstruction are very common but their relation to an objective delay of gastric emptying has been poorly investigated. A dual isotopic technique was used to evaluate patients with non-obstructive dyspepsia (idiopathic and secondary) (part 1) and to assess the effects of a new gastrokinetic agent: cisapride, on gastric emptying in such patients (part 2). Sixty patients with postprandial dyspeptic symptoms (vomiting, nausea, gastric bloating or full feeling) and without lesions at upper endoscopy were studied. They were distributed into three groups: idiopathic dyspepsia (n=31), postvagotomy dyspepsia (n=16) and dyspepsia secondary to medical disorders (n=13). All patients ingested the same ordinary meal; 99mTc sulphur colloid tagged egg white was the solid phase marker and 1"'In chloride was the liquid phase marker. In part 1, evaluation of gastric emptying in the first 50 patients shows a delay of gastric emptying rate of solids and liquids as compared with controls. Striking differences separate the three groups of patients, however, percentages of delayed gastric emptying rate of solids and or liquids averaged 90% in postvagotomy or secondary dyspepsia groups whereas it was 44% in idiopathic dyspepsia group. Moreover, liquid emptying rate was often the only one impaired in idiopathic dyspepsia, and in 12 of the 27 patients of this group the faster emptying rate of liquids as compared with that of solids (always found in normal subjects), could not be evidenced. In part 2, 10 patients entered a double blind cross over study of cisapride (8 mg intravenously). A significant increase of solid (p<OO1) and liquid (p<005) emptying rates was found in patients with initial gastric emptying delay. This study emphasises the importance of an objective evaluation of gastric emptying in the presence of symptoms of gastric stasis and suggests that specific local acting therapy may be useful in patients with identified abnormal gastric emptying.A gastric emptying delay without any gastric outlet obstruction has recently been shown in several diseases including diabetes, -3 postgastric surgical states,4 5 gastric ulcer and chronic gastritis,6 7 reflux oesophagitis,8 and systemic neuromuscular disorders.9 In most of these diseases, gastric stasis is insidious and devoid of specific symptoms.5 6 8 10On the other hand, chronic dyspeptic symptoms suggesting gastroparesis often occur without any

Prokinetic effect of gut‐oriented hypnosis on gastric emptying

“…4 Gastric dysmotility, described in up to 60% of patients, may play a role in determining at least some of the symptoms. 5 The fact that cisapride accelerates gastric emptying in various functional disorders and is more effective than placebo in functional dyspepsia [6][7][8][9] is consistent with this hypothesis.…”

“…9 Cisapride has been shown to accelerate gastric emptying and improve symptoms in functional dyspepsia. 7,8,34 In our study the aim was to compare the effect of cisapride with that of an established relaxation technique (hypnosis) reinforced by gut-oriented suggestions. 16,35 Acute administration of cisapride 10 mg p.o.…”

The action of Cisapride on the chronic constipation of paraplegia

“…These authors have shown that this agent reduces gastro-oeso phageal reflux by increasing the pressure in the region of the gastro-oesophageal junction. In gastric motility (Jian 1985;Thomforde 1985;Edwards 1987) cisapride stimulates gastric emptying. As a consequence of jejunal activity (Stacher 1986) and stimulation of colonic motility (Miller-Lissner 1985;Lee 1984;Lederer 1985) it is said to reduce transit time.…”

Effects of cisapride on constipation due to a neurological lesion

“…Recently, cis apride has been described as a non-cholinergic gastro-intestinal motor stimulant Reyntjes et al (1984), supposedly acting through increased release of acetyl choline in the intramural plexuses. Its prokinetic effects on gastro-intestinal motility have been demonstrated in patients with motility disorders of the upper gastro-intestinal tract (Jian, 1985;Smout et al, 1985), however its effect on colonic dysfunction with faecal stasis caused by lesions of the spinal cord or iatrogenic damage of the sacral nerves, has not been described. Recently, we have succesfully used cisapride in 2 patients with constipation of neurological constipation.…”