Treatment of Postoperative Paralytic Ileus with Cisapride

Abstract

The effect of cisapride on postoperative colonic motility was studied in 40 patients undergoing cholecystectomy under randomized, double-blind conditions. The patients received 10 mg of cisapride or placebo by intravenous injection starting on the day of surgery and repeated every 12 h until the 3rd postoperative day. The return of propagative motility in the colon was visualized by means of radiopaque markers and serial abdominal radiographs. Cisapride induced a significantly earlier return of propulsive motility in the right colon, as indicated by the propagation of markers from the ascending colon to the transverse colon (p less than 0.05). Radiopaque markers reached the descending colon (p less than 0.05) and the rectosigmoid colon (p less than 0.05) significantly earlier in the cisapride group than in controls. The first passage of feces occurred significantly earlier in cisapride-treated patients than in controls (p less than 0.05). The first passage of gas after surgery did not differ significantly between the groups. Our results suggest that cisapride can be used to induce earlier return of propagative motility in the colon after major abdominal surgery.

Postoperative Ileus: Pathophysiology and Treatment

“…Cisapride is a 5-HT-4 agonist that facilitates acetylcholine release from the intrinsic plexus (Tonini, 1999). Several trials have shown that cisapride actually has a beneficial effect in shortening POI (Tollesson et al, 1991;Brown et al, 1999). In our study we found that cisapride stimulated phase II of the MMC in the duodenum and jejunum.…”

Use of Chewing Gum in Reducing Postoperative Ileus After Elective Colorectal Resection: A Systematic Review

“…50, No. 12 CHEWING GUM REDUCING POSTOPERATIVE ILEUS that act on different parts of the gastrointestinal tract. 18,19,41,45 Chewing mimics food intake and stimulates the motility of human duodenum, 18 stomach, 19 and rectum.…”

“…The patients started chewing gum on Vol. 50,No. 12 CHEWING GUM REDUCING POSTOPERATIVE ILEUS the first postoperative day until first passage of flatus 22,25,26 or bowel motion.…”

“…7,8 Many pharmaceutical agents have been used to combat against ileus but only limited clinical efficacy was obtained. [9][10][11][12][13][14] Early water intake and postoperative feeding have been used to stimulate the gastrointestinal tract. [15][16][17] However, a high rate of intolerance and significant potential complications were reported.…”

Cisapride Prevents Enteric Bacterial Overgrowth and Translocation by Improvement of Intestinal Motility in Rats with Acute Liver Failure

“…Cisapride, a 5-hydroxytryptamine agonist, is a gastrointestinal prokinetic drug devoid of antidopaminergic or direct cholinergic effects and without effects on mucosal epithelial se cretion [22], The drug stimulates motility along the digestive tract mainly by enhancing the release of acetylcholine from postgan glionic mesenteric nerve endings at gastroin testinal smooth muscle cells (myenteric plex us) [23,24], Cisapride has proven effective, e.g., in treatment of constipation resulting from disturbed intestinal motility without causing adverse central nervous system ef fects [25][26][27], Also, temporary gastrointesti nal paralysis after major abdominal surgery has been improved by cisapride treatment, especially by inducing an earlier return of prop agative motility in the ileum and colon [28].…”