Effects of Metoclopramide on Esophageal Motor Activity and Esophagogastric Junction Compliance in Healthy Volunteers

Abstract

Background/AimsProkinetic drugs such as metoclopramide are frequently used as second-line therapy for patients with gastroesophageal reflux disease. However, their beneficial effects remain unclear. Esophageal motor activities and compliance of the esophagogastric junction (EGJ) are important for prevention of gastroesophageal reflux. Although metoclopramide has been reported to increase lower esophageal sphincter (LES) pressure, its effects on EGJ compliance have not been evaluated. In the present study, we investigated the effects of metoclopramide on esophageal motor activities and EGJ compliance. MethodsNine healthy male volunteers without abdominal symptoms were enrolled. Peristaltic esophageal contractions and LES pressure were examined using high-resolution esophageal manometry, while EGJ compliance was evaluated with an endoluminal functional lumenimaging probe. After obtaining baseline values for esophageal motor activities and EGJ compliance, metoclopramide (10 mg) was intravenously administered, then all measurements were repeated at 15 minutes after administration in each subject. ResultsFollowing administration of metoclopramide, mean resting LES pressure was significantly increased as compared with the baseline (13.7 ± 9.2 vs 26.7 ± 8.8 mmHg, P < 0.05). In addition, metoclopramide significantly augmented peristaltic contractions, especially in the distal esophageal segment (P < 0.05). On the other hand, distensibility index did not change after administration (4.5 ± 0.5 vs 4.1 ± 0.5 mm 2 /mmHg), suggesting no significant effect of metoclopramide on EGJ compliance. ConclusionsMetoclopramide augmented esophageal contractions without changing EGJ compliance in healthy adults.(J Neurogastroenterol Motil 2016;22:112-117)

Acotiamide Has No Effects on Esophageal Motor Activity or Esophagogastric Junction Compliance

“…16,34 Additionally, we previously found that metoclopramide had pharmacological actions similar to mosapride and augmented esophageal motor activities without changing EGJ distensibility. 17 These differences may be derived from the pharmacological mechanisms and dosage of the specific administered drugs. Furthermore, other studies have found that the effects of standard dose oral mosapride and metoclopramide on esophageal motor activity are reduced as compared to high dose and intravenous administrations.…”

“…EGJ DI was defined as the smallest CSA value in relation to the corresponding intra-bag pressure value and calculated using the following equation: smallest CSA/intra-bag pressure + intragastric pressure offset. 13,16,17…”

“…16 In another study, we found that metoclopramide (prokinetic agent that inhibits presynaptic dopamine D 2 receptors) augmented peristaltic contractions and LES pressure without reducing EGJ compliance, which were different from the effects of mosapride. 17 Accordingly, among drugs currently available, the effects on EGJ compliance by different prokinetic agents may be diverse.…”

Functional lumen imaging probe

“…Some studies report use of earlier models that consisted of a 10 –14 cm balloon that housed the 16-paired electrodes spaced at 4-mm intervals for a 6.4-cm measurement length. 9–13 …”

Anticholinergic, anti‐depressant and other medication use is associated with clinically relevant oesophageal manometric abnormalities

“…In addition, many medications such as nitrates, aminophylline, beta‐receptor agonists, benzodiazepines and anticholinergic agents are known to decrease lower oesophageal sphincter pressure 10 . In contrast, metoclopramide has been shown to augment oesophageal contraction, increasing mean resting lower oesophageal sphincter pressure with no change on oesophagogastric junction compliance as measured using impedance planimetry (EndoFLIP) 11 . These findings strongly suggest that many medications can impact oesophageal motility.…”