The clinical use of cisapride in gastro-oesophageal reflux disease, with particular focus on the long-term treatment aspects.
BACKGROUND
The healing of oesophagitis, both symptomatic and endoscopic, can be obtained with cisapride, the results being equivalent to what has been achieved with H2RAs. For many patients, however, GORD is a chronic relapsing disease.


RESULTS
At least 40-50% of patients relapse within a year of initial healing. Important predictors for relapse are the severity of symptoms, the degree of mucosal damage, and the time it takes for the initial lesions to heal. Another important predictor of relapse, as shown in the cisapride maintenance studies, is the need for PPIs, probably because the most recalcitrant patients were selected for this therapy.


CONCLUSIONS
Patients with mild or moderate disease should be treated with intermittent or prolonged therapy with cisapride or H2RAs. Patients with severe disease should be given prolonged or permanent therapy with a PPI or with cisapride in combination with either an H2RA or a PPI. For the latter group, antireflux surgery should also be considered, especially in younger patients who have a completely incompetent closing mechanism of the lower oesophageal sphincter.
Dept. of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
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Tytgat
D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D020117:Cisapride; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000473:pathology; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D010880:Piperidines / Q000627:therapeutic use*; D012008:Recurrence
D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D010880:Piperidines; D020117:Cisapride