Effects of tegaserod and erythromycin in upper gut dysmotility: a comparative study

Abstract

Objectives Tegaserod enhances upper gut transit in healthy subjects. However, its prokinetic effects on antral/small bowel motility and how this compares with erythromycin is unknown. We prospectively assessed and compared the effects of tegaserod and erythromycin on upper gut motility. Methods 22 patients (M/F = 4/18; mean age = 37) with upper gut dysmotility underwent 24 hour ambulatory antroduodenojejunal manometry with a 6 sensor solid state probe. The effects of 12 mg oral tegaserod were compared with 125 mg intravenous erythromycin by quantifying pressure wave activity and assessing motor patterns. Results Motor activity increased (p<0.05) in antrum, duodenum and jejunum with both drugs when compared to baseline period. The motor response with tegaserod was higher (p<0.05) in jejunum and occurred during the 2nd/3rd hours, whereas with erythromycin, it was higher (p<0.05) in antrum and occurred within 30 min. After tegaserod, a ‘fed-response’ like pattern was seen whereas after erythromycin, large amplitude (> 100 mmHg) antral contractions at 3 cycles/min were seen. Following tegaserod and erythromycin, phase III MMCs occurred in 12 (55%) and 8 (36%) patients respectively (p > 0.05). Conclusions Both drugs increase upper gut motility and induce MMC’s, but exert a differential response. Tegaserod produces a more sustained prokinetic effect in the duodenum/jejunum, whereas erythromycin predominantly increases antral motor activity.

Indian consensus statements on irritable bowel syndrome in adults: A guideline by the Indian Neurogastroenterology and Motility Association and jointly supported by the Indian Society of Gastroenterology

“…All bothersome symptoms should be targeted while treating these patients rather than only the predominant symptoms as suggested earlier taking into account specific IBS subtypes, symptom severity and contributing factors including psychosocial and dietary issues [63]. IBS patients with low symptom load do find significant improvement in their symptoms by use of antispasmodics [110,111], bulking agents, antidiarrheals [112,113], pro-motility agents including laxatives, [114,115] and low-FODMAP diet [42]. An outline of the management of IBS is summarized in Fig.…”

Drugs Acting on the Gut: Prokinetics, Antispasmodics, Laxatives

“…It was previously approved for treatment of females 55 years of age with constipation-predominant irritable bowel syndrome (IBS) or for chronic idiopathic constipation, however, it was withdrawn from the US market due to an increased risk of cardiovascular events. In an open label study, 22 adult patients with symptoms of upper intestinal dysmotility underwent a 24 h antroduodenal motility study comparing the effects of tegaserod (12 mg PO) and erythromycin (125 mg IV) [ 92 ]. Both medications showed significantly increased motility in the antrum, duodenum, and jejunum.…”

Drugs Acting on the Gut: Prokinetics, Antispasmodics, Laxatives

“…It was previously approved for treatment of females £ 55 years of age with constipation-predominant IBS or for chronic idiopathic constipation; however, it has subsequently been withdrawn from the US market due to an increased risk of cardiovascular events. In an open label study, 22 adult patients with symptoms of upper intestinal dysmotility underwent a 24 h antrodoudenal motility study comparing the effects of tegaserod (12 mg PO) and erythromycin (125 mg IV) [ 77 ] . Both medications showed signi fi cantly increased motility in the antrum, duodenum, and jejunum.…”