Double‐blind study of the effect of cisapride on constipation and abdominal discomfort as components of the irritable bowel syndrome

Schütze, K; Brandstätter, G; Dragosics, B; Judmaier, G; Hentschel, E

doi:10.1046/j.1365-2036.1997.133311000.x

Cited by 55 publications

(44 citation statements)

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“…There are two double-blind trials with 5-10 mg of cisapride on IBS [24,25]. No significant differences were found between placebo and cisapride, with the exception of stool passage (which improved with the drug) in one of the trials [25]. These results limit cisapride use in IBS to patients with remarkable functional symptomatology of the upper gastrointestinal tract.…”

Section: Prokinetic Drugsmentioning

confidence: 94%

“…Cisapride is a benzamide derivative with cholinergic activity in the myoenteric plexus through serotonin-mediated effects (5-HT 4 agonism). There are two double-blind trials with 5-10 mg of cisapride on IBS [24,25]. No significant differences were found between placebo and cisapride, with the exception of stool passage (which improved with the drug) in one of the trials [25].…”

Section: Prokinetic Drugsmentioning

confidence: 99%

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Update in the Therapeutic Management of Irritable Bowel Syndrome

Villanueva

Domínguez-Muñoz

Mearin

2001

Dig Dis

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Irritable bowel syndrome (IBS) is a remarkably frequent disorder that leads to relevant impairment in patients’ quality of life. Four mechanisms are involved in the pathogenesis of IBS: altered intestinal motility; increased visceral sensitivity; disturbed intestinal reflexes (intrinsic and extrinsic), and psychological disorders. The close relationship between the central nervous system and the enteric nervous system (the brain-gut axis) is the basis of the actual research on IBS therapy. It is conceivable that in the near future a better understanding of IBS pathophysiology will help us to tailor treatment for different IBS patients. At the moment, the subclassification of the diverse patterns of symptomatology allows the adjustment of treatments for IBS according to the clinical predominance of each patient. Dietary modifications like fiber supplementation, antidiarrheal agents and antispasmodic drugs are the basis of the current treatment of IBS and depend on the predominant symptom (constipation, diarrhea or pain, respectively). If severe pain is present, antidepressant agents are an appropriate alternative. However, the scientific evidence supporting this current therapeutic approach is limited. Visceral analgesics and serotonin agonists and antagonists may play an important therapeutic role in the near future. However, it is not likely that one single treatment will help every IBS patient and many of them will need a more complex approach with multidisciplinary therapy (diet, psychotherapy, medications).

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Section: Prokinetic Drugsmentioning

confidence: 94%

Section: Prokinetic Drugsmentioning

confidence: 99%

Update in the Therapeutic Management of Irritable Bowel Syndrome

Villanueva

Domínguez-Muñoz

Mearin

2001

Dig Dis

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“…hances gastrointestinal motor function and may improve the difficulty of stool passage in constipation-predomi-Thus, loxiglumide did not beneficially affect any of the gastrointestinal symptoms of IBS [69]. Similarly, the nant IBS patients but has little or no effect on the overall symptoms of constipation and abdominal discomfort CCK-B receptor antagonist CI-988 did not improve the symptoms of IBS in patients with generalised anxiety [62]. In diarrhoea-predominant IBS patients, cisapride may increase the occurrence of abdominal pain [63], per-disorder, but tended to exacerbate the diarrhoea [70].…”

Section: Inhibition Of Afferent Nerve Activitymentioning

confidence: 99%

Hypersensitivity and Hyperreactivity in the Irritable Bowel Syndrome: An Opportunity for Drug Discovery

Sanger¹

1999

Dig Dis

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The gastrointestinal tract of many patients with irritable bowel syndrome (IBS) is hypersensitive to different stimuli. The mechanisms of this hypersensitivity are unclear, but could involve enteric, visceral afferent/efferent, spinal and/or central nervous systems. Such complexity, the absence of animal models or anatomical, molecular or genetic markers of IBS, means that it is difficult to create new types of drugs which specifically treat the condition of IBS. To help in this process, current pre-clinical and early-clinical approaches are evaluated in terms of their ability to intervene within the gut-spinal cord/brain axis and inhibit gastrointestinal ‘hypersensitivity’ and ‘hyperreactivity’. Thus, by developing a rational process the pharmaceutical industry may better understand how to design truly effective drugs for the treatment of IBS.

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“…Two other high-quality trials, however, showed that cisapride was not superior to placebo in the treatment of constipation and abdominal discomfort in IBS [96,97]. It has a role as a promotility agent in the upper gastrointestinal tract.…”

Section: Constipation-predominant Ibsmentioning

confidence: 99%

Irritable Bowel Syndrome: Update on Pathogenesis and Management

Alaradi

Barkin²

2002

Med Princ Pract

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Irritable bowel syndrome (IBS) comprises a major proportion of gastrointestinal and primary care practice worldwide. The past several years have seen the rapid evolution of a new and comprehensive model of IBS based on alterations in brain-gut interactions. Alterations in the bidirectional communication between the enteric nervous system and the central nervous system are implicated in the pathogenesis of IBS. 5-Hydroxytryptamine (5-HT; serotonin), a major neurotransmitter in the gastrointestinal tract, and its receptors 5-HT3 and 5-HT4 are involved in the control of gastrointestinal function. A number of abnormal motor and sensory patterns have been reported in patients with IBS. However, it is not known whether these abnormalities are related to symptoms or have a role in establishing a diagnosis of functional gastrointestinal disorders. Visceral hyperalgesia in IBS patients can be secondary to altered receptor sensitivity at the viscus itself and altered central modulation of sensation involving psychological influences in the interpretation of these sensations. The development of diagnostic criteria for IBS helps to avoid unnecessary and costly investigations. A detailed history allows us to diagnose IBS and search for another cause if warning symptoms are present. The Rome criteria are presently used to define IBS and are currently the most widely applied criteria used in clinical diagnosis and research purposes. Abdominal pain or discomfort associated with chronic altered bowel habits are the mainstay in diagnosis, while the supportive criteria may be used to further classify IBS patients into diarrhea-predominant or constipation-predominant subgroups. Minimal diagnostic tests have been advocated in the initial diagnostic approach to patients with suspected IBS, depending on the predominant symptom. The therapeutic goals in IBS must focus on the overall well-being of the patient, including abdominal symptoms and the accompanying nonbowel symptoms and affective disorders. It is important to establish an effective physician-patient relationship and to reassure the patient once the diagnosis of IBS is made. Dietary modification may be of value in some patients with IBS. Dietary fiber is frequently recommended for patients with constipation-predominant IBS. Two novel serotonin agonists are currently under development for constipated IBS patients, tegaserod and prucalopride. Antidiarrheal agents, including loperamide and diphenoxylate, may help patients with diarrhea-predominant IBS. 5-HT3 receptor antagonists may play a role in the management of such patients in the future. Psychological treatment and antidepressants should be considered when IBS symptoms are severe or refractory or associated with psychological distress and impaired quality of life.

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Double‐blind study of the effect of cisapride on constipation and abdominal discomfort as components of the irritable bowel syndrome

Cited by 55 publications

References 0 publications

Update in the Therapeutic Management of Irritable Bowel Syndrome

Update in the Therapeutic Management of Irritable Bowel Syndrome

Hypersensitivity and Hyperreactivity in the Irritable Bowel Syndrome: An Opportunity for Drug Discovery

Irritable Bowel Syndrome: Update on Pathogenesis and Management

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