The effect of a single rectal dose of cisapride on delayed gastric emptying

Abstract

Background: Cisapride has an established prokinetic effect in patients with delayed gastric emptying. However, rectal administration of the drug might be preferred in patients with either dysphagia or nausea due to gastroparesis. Aim: To determine the effect of a single rectal dose of cisapride 60 mg on gastric emptying in patients with delayed gastric emptying. Methods: Thirty‐two patients (16 males, 16 females) with demonstrated delayed gastric emptying received a single dose of two suppositories containing either cisapride (2 × 30 mg) or placebo, according to a double‐blind randomized crossover design. Three hours after administration of the suppositories, the patients received a radio‐labelled test meal and radio‐opaque markers for measurement of gastric emptying. Results: The mean t½ after cisapride administration (76 min, 95% CI: 68–95) was significantly shorter (P = 0.005; n = 28, per‐protocol analysis) than after placebo administration (104 min, 81–126). Four hours after ingestion of the meal significantly fewer radio‐opaque markers remained in the stomach after cisapride than after placebo administration (P < 0.05). Mild to moderate adverse events, mainly involving the gastrointestinal tract, were reported in 10 patients (31%) after cisapride treatment and in four patients (13%) after placebo (N.S.; n = 32). Conclusion: A single suppository dose of cisapride 60 mg significantly accelerates gastric emptying of the solid phase of a meal and of radio‐opaque markers in patients with previously demonstrated delayed gastric emptying.

Cisapride provides symptomatic relief in functional dyspepsia associated with gastric myoelectrical abnormality

“…The results of the present study have demonstrated that cisapride was more effective than placebo for the treatment of overall dyspeptic symptoms and of postprandial bloating and discomfort in patients with abnormal baseline electrogastrograms. This response to cisapride may be related to improvement in gastric emptying, as reported in other studies 28 –31 …”

“…was more effective than 10 mg t.d.s., and that 4 weeks of treatment may be necessary for a complete normalization of gastric myoelectrical activity. Improvement of gastric slow wave rhythmicity with cisapride in patients with gastroparesis has also been reported in a number of previous studies 15 –31 …”

The effect of cisapride on dyspepsia symptoms and the electrogastrogram in patients with non‐ulcer dyspepsia

“…This open study also suggests that symptomatic improvement is most likely in NUD patients with an abnormal EGG. Trials of treatment in NUD have usually been symptom based, although there are trials where gastric function has been incorporated in the study design 27 –35 . Conventional classification of NUD subdivides the disorder into three groups according to symptoms (ulcer‐like, dysmotility‐like, reflux‐like).…”

Is Rectally Administered Cisapride an Effective Prokinetic Agent?

“…[10][11][12] The effects of rectally administered cisapride were evaluated in patients with scintigraphy-documented delayed gastric emptying due to either diabetes mellitus (4 patients) or functional disorders of gastrointestinal tract motility (24 patients). 13 Two cisapride 30-mg suppositories or two placebo suppositories were administered in a double-blind, randomized, crossover fashion. Three hours after insertion of the suppositories, a radiolabeled test meal, combined liquid and solid phase, was ingested by the subjects, and gastric emptying was evaluated by scintigraphy.…”