Effect of cisapride on chronic idiopathic constipation in children

Staiano, Annamaria; Cucchiara, Salvatore; Andreotti, Maria Rosaria; Minella, R.; Manzi, G.

doi:10.1007/bf01311229

Cited by 66 publications

(38 citation statements)

References 15 publications

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“…24 In contrast R093877 had no specific effect on rectal distension thresholds or anorectal electrosensory thresholds, despite showing a significant effect on increasing bowel frequency. Results from this study indicate that R093877 has no obvious effect on sensory or sphincter function.…”

Section: Discussionmentioning

confidence: 90%

Effect of a novel prokinetic drug, R093877, on gastrointestinal transit in healthy volunteers

Emmanuel

Kamm

Roy

et al. 1998

Gut

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Background-Stronger prokinetic agents which specifically enhance transit in different parts of the gut are required. R093877 is a novel 5-HT 4 agonist prokinetic compound which is chemically related to cisapride but believed to have greater eVect on colonic activity. Aims-To evaluate the eVects of R093877 on bowel function, upper and lower gut transit, visceral sensitivity, and sphincter function in healthy volunteers in a double blind, placebo controlled, crossover study. Methods-The study consisted of five consecutive one week periods: no drug treatment; active drug treatment with either 1 or 2 mg daily or placebo; washout; active drug or placebo; no treatment. Seventeen male subjects maintained a detailed diary of bowel function for the entire study. Orocaecal transit (breath hydrogen), whole gut transit (radio-opaque markers), and anorectal function were assessed at the end of each of the two treatment periods. Blood testing was performed to confirm compliance and for safety analysis. Results-One subject withdrew from the study due to side eVects while on placebo. Eight subjects completed the study on 1 mg and a further eight on 2 mg. Blood testing showed non-compliance in one subject on the 2 mg dose, and he was excluded from analysis of all diary and physiological data. Treatment increased the number of stools per week (placebo versus 1 mg, 7.8 versus 13.6, p=0.003; placebo versus 2 mg, 8.9 versus 11.3, p=0.15) and the percentage of loose or watery stools (24.2% versus 61.5%, p<0.04; 9.9% versus 40.0%, p<0.02). Stool frequency and consistency reverted to normal immediately after treatment. Treatment shortened orocaecal and whole gut transit in all subjects on both doses. Treatment accelerated orocaecal (76 versus 51 minutes, p=0.007; 63 versus 47 minutes, p=0.07) and whole gut (38.2 versus 27.0 hours, p=0.05; 44.8 versus 24.0 hours, p<0.04) transit, and decreased the number of retained markers ingested 36 hours previously (4.8 versus 1.8, p=0.016; 7.0 versus 4.3, p=0.033). Gut sensitivity to distension and electrical stimulation, and anal manometry, were unchanged. Transient headache occurred in seven subjects on R093877 and one subject had mild elevation of liver aminotransferases which resolved on drug cessation.Conclusions-R093877 is well tolerated by healthy subjects and has a marked and consistent eVect on stool frequency and consistency, and upper gut and colonic transit. It does not aVect visceral sensitivity or sphincter function. It holds promise for patients with large bowel symptoms or slow gut transit. (Gut 1998;42:511-516)

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Section: Discussionmentioning

confidence: 90%

Effect of a novel prokinetic drug, R093877, on gastrointestinal transit in healthy volunteers

Emmanuel

Kamm

Roy

et al. 1998

Gut

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“…In children it increases lower oesophageal sphincter pressure,6 enhances gastric emptying,7-9 and increases intestinal transit time 1011 It has been widely used in children for a variety of conditions including gastro-oesophageal reflux,6 12 13 intestinal pseudo-obstruction,14 15 and constipation 16 17. It is well tolerated by most children 2…”

Section: Discussionmentioning

confidence: 99%

Randomised controlled trial of cisapride in feed intolerance in preterm infants

Enriquez

Bolisetty

Patole

et al. 1998

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Aim-To assess the eYcacy of cisapride in reducing the time required to establish enteral feeds in preterm infants. Methods-A randomised, double blind, placebo controlled trial was conducted of 34 infants of < 32 weeks of gestation, assigned to receive either cisapride 0.2 mg/kg/dose four times daily (n=18) or placebo (n=16). Results-The time taken by the babies to tolerate full enteral feeds was not significantly diVerent between the groups (median 9.5 days vs 10 days). There was a significantly lower incidence of large gastric residuals and regurgitation in the treated group compared with the placebo group. The number of episodes of large gastric residuals per infant was also significantly less. No adverse eVects were noted. Conclusion-The routine use of cisapride in preterm infants cannot be recommended to decrease the time to establish enteral feeds. Its use may be justified for clincally significant gastric stasis or regurgitation. (Arch Dis Child Fetal Neonatal Ed 1998;79:F110-F113) Keywords: cisapride; feed intolerance; enteral feeding Despite growing knowledge in the development and physiology of the immature human gut, management of feed intolerance in low birthweight preterm babies still remains a major challenge to clinicians. The time to achieve full feeding in preterm infants is partly determined by host factors such as lower oesophageal sphincter pressure, gastric emptying time, and motility of the gut. Cisapride is a first line gastrointestinal prokinetic agent for treating motility disorders in children.2 In children it can stimulate oesophageal contractility, increase lower oesophageal sphincter pressure, reduce gastrooesophageal reflux, enhance gastric emptying time, and reduce the whole gut transit time. In an uncontrolled trial, Janssens et al 4 studied the eYcacy of cisapride in 20 preterm infants of less than 34 weeks of gestation. They showed a significant reduction in gastric residuals after 48 hours of treatment with cisapride. Feeding volume was also significantly increased during that period.We conducted a randomised, double blind, placebo controlled trial to evaluate the eYcacy of cisapride in improving feed tolerance in preterm infants of less than 33 weeks gestation at birth. We hypothesised that cisapride would decrease the time required to establish full enteral feeds. MethodsThe study was conducted at the Royal Hospital for Women from May 1994 for a period of 12 months. Informed consent was obtained from the parents of the infants. The study was approved by the hospital research ethics committee. Preterm infants with a gestational age of < 32 weeks were eligible for the study. Exclusion criteria were: major congenital malformations; birth asphyxia with a 5 minute Apgar score of less than 3; the presence or history of necrotising enterocolitis; confirmed sepsis; organic abdominal illness; and periventricular haemorrhage greater than grade 1.The end point used for sample size calculation was the time to reach full feed based on our previous 12 month infant population. We ...

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“…Later, four randomized, controlled studies tested the efficacy of cisapride in children with constipation [7•,28-30]. Initially, Staiano et al [29] showed, in 20 children randomized either to cisparide, 0.2 mg/kg three times daily, or placebo, for a 12-week period, that cisapride significantly increased stool frequency, and decreased laxative use and transit time. Later, Odeka et al [30] randomized 37 children either to cisparide, 0.2 mg/kg three times daily, or to placebo, for an 8-week period, and no significant differences were shown.…”

Section: Cisapridementioning

confidence: 97%

Advances in the management of pediatric constipation

Nurko

2000

Curr Gastroenterol Rep

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Constipation in children is a common concern. There is no single treatment; many children do not respond and continue to have chronic problems. This lack of response is multifactorial, but it is most likely related to the fact that the exact pathophysiology of constipation in children is not known. Diagnostic criteria (Rome II classification) and algorithms proposed by the North American Society for Pediatric Gastroenterology and Nutrition (NASPGN) for evaluation and treatment of children with constipation were recently published and are summarized here. The effectiveness of new treatments such as dietary interventions, prokinetic agents, biofeedback, and polyethylene-glycol electrolyte (PEG) solutions is discussed in this review.

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Effect of cisapride on chronic idiopathic constipation in children

Cited by 66 publications

References 15 publications

Effect of a novel prokinetic drug, R093877, on gastrointestinal transit in healthy volunteers

Effect of a novel prokinetic drug, R093877, on gastrointestinal transit in healthy volunteers

Randomised controlled trial of cisapride in feed intolerance in preterm infants

Advances in the management of pediatric constipation

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