Double-blind placebo-controlled study of cisapride in patients with nonspecific esophageal motility disorder accompanied by delayed esophageal transit.
BACKGROUND
Nonspecific esophageal motility disorder (NEMD) represents a difficult therapeutic challenge because of the heterogeneous nature of the esophageal motor functions. We studied the effects of cisapride on the esophageal symptoms and esophageal motor function in a group of patients with NEMD showing delayed esophageal transit.


METHODS
Seventy eligible patients were entered into a 4-week, double-blind randomized comparison of 10 mg of cisapride or placebo, four times daily. Symptom assessment, esophageal manometry after wet swallows, and esophageal scintigraphy after intake of a liquid and solid bolus were performed in each patient before and after treatment.


RESULTS
After 4 weeks of treatment cisapride significantly increased the prevalence of esophageal peristaltic contractions (percentage of total contractions, P < 0.05 versus base line and placebo) and significantly improved esophageal emptying of the solid bolus (P < 0.05 versus placebo) but not of the liquid bolus. Placebo did not have any significant effects versus base line on these variables. Both placebo and cisapride improved the distal esophageal amplitude versus base line (no significant intergroup differences). Symptom scores were significantly reduced after 4 weeks of treatment versus base line in both groups (no significant intergroup differences except for heartburn and regurgitation, P < 0.05). On global evaluation of treatment, significantly more patients in the cisapride group were rated as markedly or moderately improved, when compared with placebo.


CONCLUSIONS
The results of the present study showed that cisapride is effective and well tolerated in patients with NEMD accompanied by delayed esophageal transit. Symptomatic improvement may possibly be related to its beneficial action on the esophageal body by increasing the number of peristaltic contractions and esophageal emptying of solids.
Song
C W
CW
Dept. of Internal Medicine and Nuclear Medicine, Korea University Hospital, Seoul, Republic of Korea.
UM
S H
SH
Kim
C D
CD
Ryu
H S
HS
Hyun
J H
JH
Choe
J G
JG
D000328:Adult; D020117:Cisapride; D004311:Double-Blind Method; D015154:Esophageal Motility Disorders / Q000175:diagnosis / Q000188:drug therapy*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000187:drug effects / Q000502:physiology; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008365:Manometry; D010528:Peristalsis / Q000187:drug effects; D010880:Piperidines / Q000627:therapeutic use*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid
D005765:Gastrointestinal Agents; D010880:Piperidines; D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid; D020117:Cisapride