The Influence of Esomeprazole and Cisapride on Gastroesophageal Reflux During Anesthesia in Dogs

Abstract

Background: Gastroesophageal reflux (GER) is common in anesthetized dogs and can cause esophagitis, esophageal stricture, and aspiration pneumonia.Objective: To determine whether preanesthetic IV administration of esomeprazole alone or esomeprazole and cisapride increases esophageal pH and decreases the frequency of GER in anesthetized dogs using combined multichannel impedance and pH monitoring.Animals: Sixty-one healthy dogs undergoing elective orthopedic surgery procedures. Methods: Prospective, randomized, placebo-controlled study. Dogs were randomized to receive IV saline (0.9% NaCl), esomeprazole (1 mg/kg) alone, or a combination of esomeprazole (1 mg/kg) and cisapride (1 mg/kg) 12-18 hours and 1-1.5 hours before anesthetic induction. An esophageal pH/impedance probe was utilized to measure esophageal pH and detect GER.Results: Eight of 21 dogs in the placebo group (38.1%), 8 of 22 dogs in the esomeprazole group (36%), and 2 of 18 dogs in the combined esomeprazole and cisapride group (11%) had 1 episode of GER on impedance testing during anesthesia (P < .05). Esomeprazole was associated with a significant increase in gastric and esophageal pH (P = .001), but the drug did not significantly decrease the frequency of GER (P = .955). Concurrent administration of cisapride was associated with a significant decrease in the number of reflux events (RE) compared to the placebo and esomeprazole groups (P < .05).Conclusions and Clinical Relevance: Preanesthetic administration of cisapride and esomeprazole decreases the number of RE in anesthetized dogs, but administration of esomeprazole alone was associated with nonacid and weakly acidic reflux in all but 1 dog.

Pharmacokinetics and Acid Suppressant Efficacy of Esomeprazole after Intravenous, Oral, and Subcutaneous Administration to Healthy Beagle Dogs

“…However, PK information relating to the use of esomeprazole in veterinary medicine is not available, and little published support exists regarding esomeprazole dosages in dogs 17. IV administration of esomeprazole (1 mg/kg) and cisapride (1 mg/kg) 12–19 hours and 1–1.5 hours before anesthesia resulted in decreased gastroesophageal reflux 7. However, this evidence is insufficient to support a dosage regimen for oral and parenteral esomeprazole administration in dogs 17.…”

“…In 8‐week clinical trials involving patients with erosive esophagitis, the treatment group receiving esomeprazole showed significantly higher healing rates than patients receiving omeprazole or lansoprazole 4. In veterinary medicine, however, little information has been published about the PKs and acid suppressant efficacy of esomeprazole in dogs 7, 8…”

“…The aspiration of gastric juices, the placement of a pH electrode through a gastric fistula, and the placement of an pH catheter have been used as methods for measuring gastric pH 7, 8. Previous studies have reported that the aspiration is a relatively invasive technique that may alter gastric physiology, whereas catheterization poses risks of catheter migration and substantial discomfort 1, 13.…”

Gastroesophageal reflux in anesthetized dogs: a review

“…(2004) reported that oral administration of omeprazole every 12 h for 7 days did not decrease GER. Esomeprazole is the proton pump inhibitor studied in dogs; dogs that received IV esomeprazole (1 mg/kg) alone in a prospective randomized placebo-controlled study presented significant increase in gastric and esophageal pH, but the drug did not significantly decrease GER frequency; however, combination of esomeprazole (1 mg/kg) and cisapride (1 mg/kg) IV was associated with significant decrease of reflux in anaesthetized dogs (Zacuto et al ., 2012). Ranitidine has been used in dogs to reduce GER during anesthesia, but results vary.…”

Perioperative gastrointestinal reflux in dogs

“…A single dose of omeprazole, given four hours before the induction of anaesthesia reduces the occurrence of reflux (Panti and others 2009). However, another study found no improvement in reflux when esomeprazole was given alone (Zacuto and others 2012). Tolbert and others (2015) theorised that because PPIs require several days to reach full effect, the addition of a dose of ranitidine would reduce GER.…”