Cisapride in children with chronic intestinal pseudoobstruction. An acute, double-blind, crossover, placebo-controlled trial.
To assess the effect of cisapride on gastrointestinal motility and gastric emptying in children with chronic intestinal pseudoobstruction, 20 children (mean age, 4.9 years; 14 female and 6 male) who required special means of alimentation or who had severe symptoms confirmed by diary during 2 weeks before the study were studied. A motility catheter with recording sites in the antrum and duodenum was placed on the first day of the study and remained in place until the end of the 5-day study. Cisapride (0.3 mg/kg PO t.i.d.) or placebo was given in double-blind randomized crossover fashion, with a 2-day "washout" interval. Antroduodenal motility was recorded on days 2 and 5. Recording consisted of 4 hours of fasting and 2 hours after a complex liquid meal labeled with 99mTc. Gastric emptying was assessed for 1 hour after the meal. Based on manometry, 16 patients had neuropathic and 4 patients had myopathic disorders. Cisapride had no effect on the discrete, qualitative abnormalities found in individual records. Cisapride increased the postprandial duodenal motility index from 1180 +/- 256 mm Hg/30 min after placebo to 2385 +/- 430 mm Hg/30 min (P less than 0.05) but had no significant effect on the antral motility index. Cisapride did not alter the profound delay in gastric emptying; time to reach 50% of initial activity (T1/2) was 105 +/- 20 vs. 93 +/- 19 minutes and percentage of retention after 60 minutes (R60) 56% +/- 4% vs. 58% +/- 4% in control vs. cisapride, respectively. In summary, in children with chronic intestinal pseudoobstruction, cisapride increased postprandial duodenal motility but did not improve gastric emptying.
Di Lorenzo
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C
Department of Pediatrics, Harbor-UCLA Medical Center, Torrance.
Reddy
S N
SN
Villanueva-Meyer
J
J
Mena
I
I
Martin
S
S
Hyman
P E
PE
D002648:Child; D002675:Child, Preschool; D020117:Cisapride; D004311:Double-Blind Method; D004386:Duodenum / Q000187:drug effects / Q000503:physiopathology; D004435:Eating / Q000502:physiology; D005260:Female; D005746:Gastric Emptying / Q000187:drug effects; D005769:Gastrointestinal Motility / Q000187:drug effects*; D006801:Humans; D007223:Infant; D007418:Intestinal Pseudo-Obstruction / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008365:Manometry; D010880:Piperidines / Q000097:blood / Q000494:pharmacology* / Q000627:therapeutic use; D012702:Serotonin Antagonists / Q000097:blood / Q000494:pharmacology* / Q000627:therapeutic use
D010880:Piperidines; D012702:Serotonin Antagonists; D020117:Cisapride