Effect of intravenous metoclopramide on gastrooesophageal reflux

Glanville, J. N.; Walls, W. D.

doi:10.1136/gut.13.1.31

Cited by 7 publications

(2 citation statements)

References 9 publications

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“…The rise in tone of the lower oesophageal sphincter presumably assists in preventing reflux, while the increased pressure of peristaltic contractions may assist oesophageal emptying. Our findings conflict with those of Glanville and Walls (1972) who, using standard radiological techniques, found that intravenous metoclopramide failed to change the incidence of 2* gastrooesophageal reflux during barium meal examinations. The reason for the difference probably lies in the methodology.…”

Section: Discussioncontrasting

confidence: 99%

Metoclopramide in gastrooesophageal reflux

Stanciu¹,

Bennett²

1973

Gut

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SUMMARY In 30 patients with gastrooesophageal reflux, intravenous metoclopramide (Maxolon) has been shown to increase the gastrooesophageal sphincter pressure. The rise is dose-related until a maximum pressure, proportional to the resting sphincter tone, is reached. The effect is reversed by atropine. Peristaltic waves are increased in pressure by metoclopramide.In 18 patients with gastrooesophageal reflux intravenous metoclopramide diminished the frequency of reflux episodes and increased the rate at which the oesophagus emptied itself of an acid load.Metoclopramide (Maxolon) has been shown to have a number of actions on gastrointestinal motility but little attention has been paid to its effects on the oesophagus. The one detailed study published (Heitmann and Moller, 1970) clearly demonstrates that in healthy adults the drug raises the pressure of the gastrooesophageal sphincter and increases the height and duration of peristaltic contractions in the distal oesophagus. An obvious potential application of these actions is to prevent gastrooesophageal reflux, and we have studied its effect in patients with symptoms of 'reflux oesophagitis'. in 16 men and 14 women aged 18 to 77 years (mean 51.2 years) with symptoms of gastrooesophageal reflux (heartburn, acid regurgitation, and discomfort on drinking hot fluids). Radiologically eight had been shown to have a hiatus hernia and 11 gastrooesophageal reflux, and all had abnormal gastrooesophageal reflux detected by 15-hour intraoesophageal pH recordings (Stanciu and Bennett, to be published). Three patients had previously had truncal vagotomy and pyloroplasty for duodenal ulceration.Recordings were made with the patients supine by withdrawing the previously swallowed tube assembly from the stomach to oesophagus in 0.5 cm steps. At each point in the oesophagus, pressures were recorded both during quiet breathing and during swallows. In 20 patients the procedure was repeated after the intravenous injection of 5 ml 0.9 % sodium chloride solution, and again after 10 mg metoclopramide intravenously. The patients were not aware which injection contained the drug, but had previously given consent to the study.In another 10 patients the solutions were given by continuous intravenous infusion while the distal catheter opening was held in the gastrooesophageal sphincter. At first, 0.9 % sodium chloride was infused and then metoclopramide (40 mg/100 ml saline) at increasing rates. The infusion was continued at each rate for five to six minutes. In six of these patients atropine (0.3 mg/kg) was given intravenously at the end of the metoclopramide infusion. RESULTSThe mean resting end-expiratory gastrooesophageal sphincter pressure (average of recorded pressure in all patients) before metoclopramide was 11.8 ± SD 5.7 cm water. There was no significant change after 275 on 9 May 2018 by guest. Protected by copyright.

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Section: Discussioncontrasting

confidence: 99%

Metoclopramide in gastrooesophageal reflux

Stanciu¹,

Bennett²

1973

Gut

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“…A statistical association has been demonstrated between the intraluminal high pressure zone (HPZ) at the cardia and gastrooesophageal reflux (Winans and Harris, 1967;Thurer, DeMeester, and Johnson, 1974). Many hormones and drugs have been shown to affect this high pressure zone, but no concomitant change in reflux status has been reported (Glanville and Walls, 1972;Moossa, Cooley, and Skinner, 1973).…”

mentioning

confidence: 99%

The effects of premedication drugs on the lower oesophageal high pressure zone and reflux status of rhesus monkeys and man.

Hall¹,

Moossa²,

Clark³

et al. 1975

Gut

111

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SUMMARY Thirty-five human volunteers and eight Rhesus monkeys were studied with standard gastrooesophageal manometric techniques and their reflux status was evaluated with a pH probe placed in the lower oesophagus. Morphine sulphate, pethidine hydrochloride, or diazepam was given intravenously until drowsiness was induced.The manometric and pH studies were repeated. All three drugs decreased the lower oesophageal high pressure zone and increased the probability of reflux in both monkeys and man. These findings are relevant in the preparation of patients for surgery since gastrooesophageal reflux and pulmonary aspiration may be a problem in the pre-and postoperative phases.

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