Lack of effect of metoclopramide and domperidone on esophageal peristalsis and esophageal acid clearance in reflux esophagitis

Abstract

The acute effects of oral metoclopramide (40 mg/day) and domperidone (80 mg/day) on esophageal motor activity and acid reflux were assessed in a randomized, double-blind, placebo-controlled study in 20 patients with erosive reflux esophagitis. Esophageal motor function was assessed by standard manometry with wet swallows, and reflux events were evaluated by ambulatory 24-hr pH-monitoring. Both drugs caused a significant (P less than 0.05) increase in lower esophageal sphincter pressure lasting at least 120 min. However, neither esophageal body motility, duration of esophageal exposure to acid, nor esophageal clearance were effected by drug administration in comparison to placebo. Side effects were reported in two patients who received metoclopramide, while no adverse effects occurred after domperidone intake. In conclusion, the so-called motility agents metoclopramide and domperidone have few acute effects on esophageal motility in patients with erosive reflux esophagitis.

Clinical Utility of Selective Esophageal Manometry in a Tertiary Care Setting

“…However, presence of IMD was not associated with significant alteration in treatment resulting in low clinical utility in our study group. This finding is consistent with earlier studies demonstrating no change in IMD after antireflux surgery [13], oral prokinetic therapy [14,15] or acidsuppressive medications [16,17]. Esophageal manometry is also advised routinely in patients being considered for anti-reflux surgery.…”

Gastrointestinal Motility Disorders: An Update

“…Previous studies have shown that neither metoclopramide nor domperidone effectively stimulate esophageal body motility, although both agents increase LES resting pressure in healthy volunteers [21,22] . Although several studies initially reported that cisapride increased both LES pressure and the amplitude of contractions in the distal esophagus [23][24][25] , a number of other studies failed to confi rm any direct prokinetic effects of cisapride on the esophagus [20,26] .…”

Beneficial effect of the 5‐HT1A receptor agonist buspirone on esophageal dysfunction associated with systemic sclerosis: A pilot study

“…It seems, therefore, that the reported effectiveness of domperidone stems from the acceleration of gastric emptying rather than from its effect on esophageal motor function. 10,11,18 We used the new technique of HRM, allowing a better evaluation of esophageal motility and a more detailed investigation of the effect of drugs on esophageal motor function. 8,19 Our data show that esophageal Esophageal peristalsis and LES function are under control of the autonomic and enteric nervous systems.…”

“…Domperidone, a peripheral dopamine antagonist, is currently the most common prokinetic agent used in clinical practice in patients with SSc, although data on its effect on esophageal motility are conflicting. 10,11 Recent data suggest that buspirone, an orally available 5-HT 1 A receptor agonist, enhances esophageal peristalsis and LES function in healthy subjects. 13,14 Given the paucity of drugs that are able to enhance esophageal motor function in SSc, 15 we conducted an open-label, pilot study in 20 symptomatic SSc patients aiming to test the hypothesis that buspirone could exert a beneficial acute effect on esophageal motor dysfunction and LES pressure.…”

“…8 Currently, there are two main medical therapeutic options for SSc patients with esophageal involvement: (i) antisecretory agents, such as proton pump inhibitors (PPIs), which are effective for treating GERD, and (ii) prokinetic agents, including metoclopramide, cisapride, erythromycin, octreotide and domperidone, aiming to improve the SSc-associated esophageal dysmotility and GERD symptoms. [9][10][11][12] It has been reported that metoclopramide and erythromycin may increase LES pressure in SSc patients, while cisapride has been shown to increase LES pressure and amplitude of distal esophageal body peristalsis. 9 However, use of these agents is restricted due to safety profile issues and administration route problems.…”