Effects of ranitidine and cisapride on acid reflux and oesophageal motility in patients with reflux oesophagitis: a 24 hour ambulatory combined pH and manometry study.

Abstract

The effect of ranitidine and cisapride on acid reflux and oesophageal motility was investigated in 18 patients with endoscopically verified erosive reflux oesophagitis. Each patient was treated with placebo, ranitidine (150 mg twice daily), and ranitidine (150 mg twice daily) plus cisapride (20 mg twice daily) in a double blind, double dummy, within subject, three way cross over design. Oesophageal acidity and motility were monitored under ambulatory conditions for 24 hours on the fourth day oftreatment, after a wash out period of 10 days during which patients received only antacids for relief of symptoms. Acid reflux was monitored by a pH electrode located 5 cm above the lower oesophageal sphincter. Intraoesophageal pressure was simultaneously recorded from four transducers placed 20, 15, 10, and 5 cm above the lower oesophageal sphincter. Upright reflux was three times higher than supine reflux (median (range) 13-3 (3 7-35 0)% v 3-7 (0-37-6)% of the time with pH<4*0, p<001, n=18). Compared with placebo, ranitidine decreased total reflux (from 10*0 (3.2-32.6)% to 6-4 (1.2-22-9)%, p<001), upright reflux (p<005), supine reflux (p<0001), and postprandial reflux (p<0-01), but did not affect oesophageal motility. The combination of ranitidine with cisapride further diminished the acid reflux found with ranitidine -that is, cisapride led to an additional reduction of total reflux (from 6*4 (1-2-22.9)% to 3-7 (1.0-12.7)%, p<001), supine reflux (p<0.05), and postprandial reflux (p<O05). Cisapride also reduced both the number (p<0-01) and duration (p<0.

Cisapride inhibits meal‐stimulated gastric acid secretion and post‐prandial gastric acidity in subjects with gastro‐oesophageal reflux disease

“…Although the inhibition of gastric acid secretion is known to decrease the time that the oesophageal pH < 4, 8,[36][37][38] gastric acidity has received limited attention with respect to its potential underlying role in oesophageal acid exposure in GERD. [39][40][41][42][43][44][45] The present finding that cisapride decreases post-prandial oesophageal acid exposure in subjects with GERD agrees with previous findings by others, [11][12][13][14][15] who have attributed this action of cisapride to its motility effects on the lower oesophageal sphincter pressure, oesophageal peristalsis and gastric emptying. [11][12][13][14][15] Our present results, however, indicate that the decrease in oesophageal acidity can be explained by a cisapride-induced decrease in gastric acidity.…”

Maintenance therapy with cisapride after healing of erosive oesophagitis: a double‐blind placebo‐controlled trial

“…There is no doubt that cisapride does have a role to play in the treatment of GERD, particularly in those with mild disease and in symptomatic relief. 23, 26±28 Cisapride has recently been shown to have an adjuvant effect when used with an H 2 -receptor antagonist both in reducing acid re¯ux 23 and in reducing the relapse rate in mild oesophagitis below that achieved with ranitidine alone. 29 Perhaps combination therapy is the way ahead for prokinetic agents in moderately severe oesophagitis, although it remains to be seen if this is cost-effective.…”

“…11,21 Despite this signi®cant improvement in lower oesophageal sphincter pressure, none of the previously reported bene®ts regarding pH monitoring (increased acid clearance and decreased number of re¯ux events) were seen. 22,23 This study used the manufacturer's recommended GERD maintenance therapy dose (cisapride 20 mg nocte) and it seems appropriate therefore from a clinical point of view to assess this dose. It is possible that a higher dose of cisapride may produce better results.…”

A rational approach to uninvestigated dyspepsia in primary care: review of the literature

“…[137][138][139][140] Besides acid suppressive drugs, prokinetics, especially cisapride, have been advocated for the empirical treatment of uninvestigated dyspepsia. This drug is shown to be of benefit in GORD [141][142][143][144][145][146][147][148][149][150][151][152] and functional dyspepsia, [153][154][155][156][157][158][159][160] and may have some efficacy in peptic ulcer disease. [161][162][163][164] Recently, however, serious cardiac side effects of cisapride were reported and, for that reason, the drug has been withdrawn from the US market.…”