Effects of cisapride on abnormally prolonged endogastric alkalinity time and delayed gastric emptying in cirrhotic patients.
OBJECTIVE
An abnormally prolonged alkalinity time in endogastric long-term pH monitoring has been previously demonstrated in cirrhotic patients. Recently a growing body of evidence suggest the existence of severe abnormalities of gastric emptying in the same patients and more generally of gastrointestinal motility changes in many portal hypertensive animal models. Assuming that there was a good correlation between endogastric alkalinity and a delayed emptying of gastric bile reflux, the aim of this study was to evaluated the effect of a gastrokinetic drug, Cisapride, both on circadian gastric pH and on gastric emptying in cirrhotic patients compared with controls.


METHODS
Ten in patients with chronic liver disease and portal hypertension (six males, four females, median age 49.5, range 28-59) were enrolled. The control group included twelve inpatients without cirrhosis (seven females and five males, average age 45 years, range 31-54) free from endoscopic esophagogastro-duodenal lesions. The subjects were submitted to a 24h endogastric pH monitoring and gastric emptying study before and after administration of Cisapride (10 mg tid for three days). To gastric emptying study we used an ultrasonographic method evaluating the ratio between the antropyloric region volume before and at a fixed time after a solid/liquid standard meal.


RESULTS
Basal 24 h gastric pH monitoring in cirrhotic patients showed a significant prolonged time of alkalinity (pH conventionally over 4) during the entire registration and mainly in postprandial period vs controls. The same patients group showed also a delayed gastric emptying when compared to controls. Cisapride administration significantly reduced both the abnormally prolonged alkalinity time and delayed gastric emptying in cirrhotic group without affecting the same parameters in the control group.


CONCLUSIONS
Cisapride significantly reduces both the delayed gastric emptying time and the abnormally prolonged alkalinity time in cirrhotic group. Taken together, the results offered an indirect evidence that abnormally prolonged alkalinity in cirrhotic patients may be due, at least in part, to changes in gastroduodenal motility leading to a reduced gastric clearance of potentially noxious duodeno-gastric alkaline reflux.
Pimpo
M T
MT
Department of Internal Medicine and Public Health, University of L'Aquila, Italy.
Frieri
G
G
Saltarelli
P
P
Ciccocioppo
R
R
Aggio
A
A
Marchetti
G
G
Taddei
G
G
Carlei
F
F
Lygidakis
N J
NJ
Onori
L
L
D000328:Adult; D002908:Chronic Disease; D020117:Cisapride; D005260:Female; D005744:Gastric Acid; D005746:Gastric Emptying / Q000187:drug effects*; D005765:Gastrointestinal Agents / Q000494:pharmacology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006975:Hypertension, Portal / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010880:Piperidines / Q000494:pharmacology*; D013997:Time Factors
D005765:Gastrointestinal Agents; D010880:Piperidines; D020117:Cisapride