Effects of oral cisapride on small bowel motility in irritable bowel syndrome

Abstract

Background: Cisapride has been reported to improve symptoms in patients with constipation‐predominant irritable bowel syndrome. Aim: To compare the effects of a 24‐h oral dose regimen of cisapride on interdigestive and post‐prandial small bowel motor activity in irritable bowel syndrome patients with predominant constipation, irritable bowel syndrome patients with predominant diarrhoea and healthy subjects. Methods: In 12 irritable bowel syndrome patients (11 females, aged 44 ± 12 years)—constipation‐predominant (irritable bowel syndrome‐C, n=5) and diarrhoea‐predominant (irritable bowel syndrome‐D, n=7)—and six healthy subjects, small bowel motor activity was continuously recorded using an ambulatory technique over a 48‐h period. Subjects received, in single‐blind fashion, placebo tablets q.d.s. in the first 24 h then cisapride 10 mg q.d.s. in the second 24 h. Additional control groups were 13 healthy subjects (eight females, aged 39 ± 13 years) and 10 irritable bowel syndrome patients (10 females, aged 49 ± 14 years) who were studied in identical fashion but who did not receive cisapride. Results: Cisapride increased migrating motor complex phase 2 motility index in both irritable bowel syndrome‐D (P < 0.01) and irritable bowel syndrome‐C (P < 0.05) patients, as well as in healthy subjects (P < 0.01). An increase in fasting discrete clustered contractions occurred in irritable bowel syndrome‐D patients (P < 0.001) and in healthy subjects (P < 0.01), but not in irritable bowel syndrome‐C patients; the proportion of discrete clustered contractions that were propagated, however, increased only in irritable bowel syndrome‐D patients (P < 0.001). In addition, cisapride resulted in an increase in post‐prandial motility index in irritable bowel syndrome patients (P < 0.05). Such motor alterations were not observed during the 48‐h recording period in the healthy or irritable bowel syndrome patient control groups who did not receive cisapride. Conclusions: Oral cisapride influences interdigestive and post‐prandial small bowel motor activity in both irritable bowel syndrome patients and healthy subjects; the effects of cisapride may be more marked in patients with predominant diarrhoea than in patients with predominant constipation.

The neurobiology of stress and gastrointestinal disease

“…123 In the most common functional gastrointestinal disorders, IBS and FD, persistent alterations of autonomic responsiveness is likely to play a role in altered bowel habits and alteration in gastric emptying, respectively. Evidence for such alterations in IBS includes increased responses of distal colonic motility in response to laboratory stress121 and possibly food intake124 and delayed gastric emptying in a subset of patients 125…”

The role of diet in the pathogenesis and management of irritable bowel syndrome (Review)

“…Abnormal gastrointestinal motility and visceral hypersenstivity have been reported in IBS patients (115)(116)(117)(118)(119)(120)(121)(122)(123)(124)(125)(126)(127)(128). It has been speculated that this abnormality is caused by genetic, psychosocial factors and stress.…”

Cisapride treatment of constipation–predominant irritable bowel syndrome is not superior to placebo

“…Unfortunately, similar measurements of intestinal transit in IBS patients were not repeated with cisapride by other investigators. However, Evans et al 14 . recorded the direct effects of cisapride on small bowel motility.…”