Factors Affecting Short- and Long-Term Outcome of a Short Therapeutic Trial with Cisapride in Dyspeptic Patients: General Discussion

Heyse, P.; Rambaldo, R.; Hazelhoff, B.

doi:10.3109/00365529309098324

Cited by 21 publications

(12 citation statements)

References 9 publications

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“…[1, 9,56,57] In randomised comparative studies, cisapride was at least as effective as domperidone, metoclopramide, clebopride and ranitidine in improving symptoms of functional dyspepsia.l I ,9,5s.60] It has been suggested that cisapride is most effective in patients with motility-like functional dyspepsia. [59] Symptom improvement following treatment with cisapride has been observed in patients with functional dyspepsia refractory to metoclopramide or domperidone in a double-blind placebo-controlled study.…”

Section: Functional Dyspepsiamentioning

confidence: 99%

A Risk-Benefit Assessment of Cisapride in the Treatment of Gastrointestinal Disorders

1995

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Cisapride is a substituted benzamide compound that stimulates motor activity in all segments of the gastrointestinal tract by enhancing the release of acetylcholine from the enteric nervous system. Cisapride is administered orally in the treatment of gastro-oesophageal reflux disease, functional dyspepsia, gastroparesis, chronic intestinal pseudo-obstruction syndromes and chronic constipation. In gastro-oesophageal reflux disease in both adults and children, cisapride provides symptomatic improvement and mucosal healing. Long term treatment with cisapride is effective in the prevention of relapse of oesophagitis. Cisapride improves gastric emptying rates and improves symptoms in patients with gastroparesis of various origins. Unlike domperidone and metoclopramide, long term administration of cisapride seems to result in persistently enhanced gastric emptying. Cisapride is also effective in improving symptoms in patients with functional dyspepsia. In comparative studies in patients with functional dyspepsia, cisapride was at least as effective as metoclopramide, domperidone, clebopride, ranitidine and cimetidine. Cisapride increases stool frequency and reduces laxative consumption in patients with idiopathic constipation. Severe cases of slow transit constipation seem refractory to cisapride. Clinical studies also indicate that cisapride might be effective in the treatment of chronic intestinal pseudo-obstruction, postoperative ileus, peptic ulcer and irritable bowel syndrome. Further clinical studies are warranted to define the role of cisapride in these conditions. The dosage of cisapride ranges from 5mg 3 times daily to 20mg twice daily. Cisapride is generally well tolerated, both during short and long term treatment. In children, cisapride is also well tolerated in doses of 0.2 to 0.3 mg/kg, 3 to 4 times daily.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Functional Dyspepsiamentioning

confidence: 99%

A Risk-Benefit Assessment of Cisapride in the Treatment of Gastrointestinal Disorders

1995

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“…Only limited information on the relationship between gastrointestinal motor abnormalities and dyspeptic symptoms is available from therapeutic trials with prokinetic agents. Large‐scale clinical trials have demonstrated that cisapride improves symptoms in dyspeptic patients 9 –11 . However, the sub‐groupings in these studies were not based on the identification of predominant symptoms, as these studies pre‐date this approach.…”

Section: Clinical Utility Of Predominant Symptomsmentioning

confidence: 99%

Pain versus discomfort—is differentiation clinically useful?

Stanghellini

2001

Aliment Pharmacol Ther

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Functional dyspepsia is highly variable in its clinical presentation and multifactorial in its underlying causes. Since many of the symptoms included in the definition of dyspepsia are intuitively suggestive of different pathogenic mechanisms, it has been proposed that patients with functional dyspepsia be divided into distinct dyspepsia sub‐groups according to symptom clusters. The goal was to classify patients more homogeneously for research purposes as well as to target treatment. However, recent epidemiological, pathophysiological, and clinical studies indicate that a priori definitions based on the presence/absence of symptoms or clusters of symptoms have no clinical utility due to the considerable overlap between symptoms, as well as the poor correlation between pathogenic factors and responses to treatment. Attention is now focused on identifying predominant symptoms. Recent studies suggest that the analysis of predominant symptoms, demographic features, and overlapping digestive syndromes can help to identify dyspepsia sub‐groups with different underlying pathophysiological features and aid in selecting appropriate treatment. The utility of this approach has been demonstrated in gastro‐oesophageal reflux disease, which can be reliably diagnosed and managed on the basis of the presence and severity of the predominant symptom, heartburn. It is likely that precise symptom definitions and history‐taking will be of pivotal importance in management strategies for functional dyspepsia.

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“…Thus, we should give appropriate care to patients with severe dyspepsia. However, a previous long-term study using cisapride showed that symptom severity prior to treatment is not a significant factor [20]. Further investigations are required regarding this predictive factor.…”

Section: Discussionmentioning

confidence: 97%

“…In a therapeutic trial with cisapride in patients with dyspepsia, symptom resolution during short-term treatment decreased the recurrence in the long-term follow up after cessation of cisapride [20]. It seems to be ideal to resolve symptoms during the initial treatment period.…”

Section: Discussionmentioning

confidence: 99%

Adherence to an Acotiamide Therapeutic Regimen Improves Long-Term Outcomes in Patients with Functional Dyspepsia

Shinozaki

Osawa

Sakamoto

et al. 2017

JGLD

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Background & Aims: Long-term outcomes in patients with functional dyspepsia remain elusive. Acotiamide, a prokinetic drug, has been available in Japan since 2013. The aim of this study was to assess long-term outcomes in patients with functional dyspepsia treated with acotiamide.Methods: We retrospectively reviewed 79 consecutive patients with functional dyspepsia whose symptoms improved with acotiamide therapy and who were followed for more than one year. All patients underwent esophagogastroduodenoscopy prior to acotiamide therapy. The mean follow-up was 1.9 (range, 1.0-3.3) years. We assessed the patients’ symptom severity using the Izumo scale, which reflects changes in various abdominal symptoms.Results: At one year, dyspepsia symptoms recurred in 25% (20/79) of the patients. In multivariate analysis, severe dyspepsia was significantly associated with increased recurrence (odds ratio [OR] 15.04, 95% confidence interval [CI] 1.73-130.47, p=0.013). Continued use of acotiamide for one year diminished the recurrence of dyspepsia symptoms significantly (OR 0.16, 95%CI 0.04-0.61, p=0.006). The influence of these significant predictors on long-term outcomes was analyzed using the Kaplan-Meier method. Patients with severe dyspepsia before starting acotiamide had significantly more recurrences than those with mild symptoms (p=0.004, log-rank test). Patients who continued acotiamide therapy throughout the follow-up period had significantly fewer recurrences than those who stopped therapy (p<0.001).Conclusions: Over the long-term, patients with functional dyspepsia have a considerable rate of recurrence of dyspepsia. Severe dyspepsia before treatment increases the recurrence rates, while adherence to an acotiamide therapeutic regimen decreases recurrence rate.Abbreviations: QOL: quality of life; EPS: epigastric pain syndrome; PDS: postprandial distress syndrome; EGD: esophagogastroduodenoscopy; GERD: gastroesophageal reflux disease.

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Factors Affecting Short- and Long-Term Outcome of a Short Therapeutic Trial with Cisapride in Dyspeptic Patients: General Discussion

Cited by 21 publications

References 9 publications

A Risk-Benefit Assessment of Cisapride in the Treatment of Gastrointestinal Disorders

A Risk-Benefit Assessment of Cisapride in the Treatment of Gastrointestinal Disorders

Pain versus discomfort—is differentiation clinically useful?

Adherence to an Acotiamide Therapeutic Regimen Improves Long-Term Outcomes in Patients with Functional Dyspepsia

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