Prucalopride reduces the number of reflux episodes and improves subjective symptoms in gastroesophageal reflux disease: a case series

Abstract

IntroductionTreatment of persistence to proton pump inhibitors or non-acid reflux episodes in patients with gastroesophageal reflux disease is challenging. Prucalopride, a selective high affinity serotonin (5-HT4) receptor agonist, might offer a possible new therapeutic alterative.Case presentationsWe report four chronically constipated female gastroesophageal reflux disease-patients with reflux symptoms and an increased number of reflux episodes in combined esophageal pH and multichannel impedance monitoring treated with prucalopride (2mg per day). Symptoms were persistent to proton pump inhibitors and ranitidine. Gastroesophageal reflux was detected by pH or multichannel impedance (MII) monitoring. Numbers of all reflux episodes as well as non-acid reflux episodes were reduced in all of our patients. The objective findings were concordant with subjective reports of symptom relief. There were no major adverse events in any patient during therapy with prucalopride.ConclusionAdministration of prucalopride showed promising results in the treatment of persisting or weakly and/or non-acid reflux episodes in our case series in four constipated patients. Therefore, prucalopride can be regarded as a possible therapeutic option in the treatment of standard proton pump inhibitor-persistent reflux in the chronically constipated patient. However, further prospective trials are needed to prove our findings.

Regionally dependent neuromuscular functions of motilin and 5‐HT4 receptors in human isolated esophageal body and gastric fundus

“…Compared with motilin, 5‐HT 4 agonists with good intrinsic activity and selectivity of action have greater potential to improve impaired esophageal motility, reported in a substantial number of patients with non‐obstructed dysphagia and also GERD . This possibility is supported by reports of prucalopride reducing reflux in patients with GERD (also suffering from constipation, the reason for treatment with prucalopride) and decreasing esophageal acid exposure in volunteers . However, whereas metoclopramide and prucalopride can also facilitate cholinergic activity in the human gastric antrum (consistent with an ability to increase gastric emptying), the degree of facilitation by either drug was markedly smaller than that achieved by motilin receptor activation, suggesting a weaker ability to promote gastric emptying .…”

Pharmacologic treatment of GERD: Where we are now, and where are we going?

“…189 Although specifically designed clinical trials are lacking, some case reports suggest its efficacy in controlling GERD symptoms refractory to PPI treatment. 190 In a randomized controlled trial of typical GERD patients, no additive effect on symptom improvement was noted when domperidone was used. 191 Despite the well-known cardiac risk of domperidone, studies of real-life use reported a very limited QT effect at low daily doses.…”

“…A small study showed that prucalopride can lead to improved gastric emptying and decreased esophageal acid exposure 189 . Although specifically designed clinical trials are lacking, some case reports suggest its efficacy in controlling GERD symptoms refractory to PPI treatment 190 . In a randomized controlled trial of typical GERD patients, no additive effect on symptom improvement was noted when domperidone was used 191 .…”

Gastrointestinal pharmacology: practical tips for the esophagologist

“…32 Despite the lack of specifically designed clinical trials, some case reports suggest its efficacy in controlling GERD symptoms refractory to PPI treatment. 33 Another 5HT 4 receptor agonist from the same chemical class, revexepride (at three different doses), failed to control regurgitation in patients with GERD symptoms partially responsive to PPIs. 34 In addition, the drug was no more effective than placebo at improving reflux parameters.…”