The effect of cisapride on gastro‐oesophageal dysfunction in systemic sclerosis: a controlled manometric study.

Abstract

1. Cisapride is a novel prokinetic drug which facilitates or restores motility throughout the gastrointestinal tract. Its mechanism of action is thought to involve enhancement of acetylcholine release in the myenteric plexus of the gut. 2. The effect of intravenous cisapride 10 mg on gastro‐oesophageal dysfunction was investigated in 20 patients with systemic sclerosis, using a double‐blind, randomised, cross‐over, placebo‐controlled manometric study design. 3. The increase in lower oesophageal sphincter pressure was significantly higher after cisapride (mean +/‐ s.e. mean, 8.3 +/‐ 2.1 cm H2O) than after placebo (mean +/‐ s.e. mean. 0.1 +/‐ 0.3 cm H2O) (P less than 0.001). The increase in the number of fundic gastric contractions during the 30 min study period was significantly higher after cisapride (mean +/‐ s.e. mean, 7.7 +/‐ 2.3) than after placebo (mean +/‐ s.e. mean, 0.9 +/‐ 0.6) (P less than 0.01). 4. No serious clinical adverse effects were observed. 5. The study demonstrates that intravenous cisapride induces a significant increase in lower oesophageal sphincter pressure and in the number of fundic gastric contractions, which may be beneficial in the treatment of scleroderma gastro‐oesophageal dysfunction. Further long‐term studies of the effect of oral cisapride in patients with systemic sclerosis are warranted.

The laryngeal and esophageal manifestations of Sjögren’s syndrome

“…Cisapride is the best known of the prokinetics; however, results of esophageal motility improvement studies are mixed at best, with some investigators showing positive effects and others demonstrating no benefit [58][59][60][61]. Independent of its effect on motility, cisapride has been shown to increase salivary volume and bicarbonate secretion [62].…”

Gastrointestinal motility disorders in scleroderma

“…In the esophagus, cisapride increases the LES pressure (50,86), increases the amplitude of peristaltic contractions (87), but has little effect on esophageal emptying (50,51). In the stomach, cisapride increases both liquid and solid emptying via increasing both fundic and antral contractions and improving antroduodenal coordination (87)(88)(89).…”

Systemic Sclerosis

“…Cisapride, a serotonin 5-HT 4 receptor agonist, was found to have a beneficial effect on gastric emptying and lowering esophageal pressure in a small, randomized, controlled study. 22 However, because of concerns about long QT syndrome and severe arrhythmias, the medication was withdrawn from the market in some countries. Domperidone, a dopamine D2 receptor antagonist, increases the tonus of the inferior esophagus and the peristalsis of the antrum and is a safer drug than cisapride.…”