title: Metoclopramide in gastroesophageal reflux of infancy.
abstract: This study examined the effect of metoclopramide on lower esophageal sphincter (LES) pressure, and frequency and duration of reflux episodes in 28 children (mean age (+/- SD) 9 +/- 11 months) referred for evaluation of gastroesophageal reflux (GER). Esophageal manometry was performed before and after one intravenous dose of metoclopramide (0.125 mg/kg), and esophageal pH was monitored over a 24-hour baseline period, followed by oral metoclopramide therapy (0.125 mg/kg four times a day, for 24 hours.) During pH monitoring, patients received diet for age and were kept in the prone position with the head elevated 45 degrees while sleeping. Eight patients entered a 6-month double-blind, placebo-controlled trial of metoclopramide. Metoclopramide significantly (P = 0.04) increased end-expiratory LES pressure, from 14.9 +/- 7.5 mm Hg to 18.6 +/- 6.8 mm Hg. However, there was a significant (P less than 0.05) increase in the number of reflux episodes/24 hours, and no significant change in percentage of time pH was less than 4, number of episodes lasting greater than 5 minutes, or the longest episode of reflux between the 24-hour baseline and M periods. LES pressure did not correlate well with any of these measurements (r = 0.2). In the controlled trial, the three patients receiving metoclopramide, but none of those receiving placebo, were withdrawn by their parents because of exacerbation of GER symptoms and marked irritability (P = 0.01). In the placebo group, symptoms improved in four infants, but did not change in one. The use of metoclopramide in the treatment of GER of infancy needs to be reconsidered.
authors.affiliation: Division of Paediatric Gastroenterology and Nutrition, Alberta Children's Hospital, Calgary, Canada.
authors.forename: H M
authors.initials: HM
authors.lastname: Machida
authors.forename: D A
authors.initials: DA
authors.lastname: Forbes
authors.forename: D G
authors.initials: DG
authors.lastname: Gall
authors.forename: R B
authors.initials: RB
authors.lastname: Scott
mesh_terms: D004311:Double-Blind Method; D004941:Esophagitis / Q000503:physiopathology; D004943:Esophagogastric Junction / Q000187:drug effects; D004947:Esophagus / Q000187:drug effects; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use*; D011312:Pressure
chemical_list: D008787:Metoclopramide