The role of age and salivation in acid clearance in symptomatic patients with gastro-oesophageal reflux disease.
BACKGROUND
Cisapride has been shown to have not only prokinetic effects, but also salivary stimulating effects. Both of these mechanisms play an important role in the acid clearance of the oesophagus.


OBJECTIVE
To access the efficacy of cisapride in facilitating acid clearance in patients with symptomatic gastro-oesophageal reflux disease.


METHODS
Fifteen older adults and 15 younger adults with symptomatic gastro-oesophageal reflux disease completed the study. The acid clearance test was accomplished by infusing 15 mL of 0.1 N HCl into the distal oesophagus, and the number of swallows was determined to achieve an oesophageal pH of 4.0. This was accomplished under baseline conditions and salivary stimulation with a peppermint lozenge. After 1 week of treatment with cisapride (10 mg, q.d.s.), the acid clearance test was repeated.


RESULTS
The lozenge produced a significant decrease in the number of swallows compared to baseline in both groups (P < 0.01). There was a significant decrease in the number of swallows after the treatment with cisapride compared to baseline in both groups (P < 0.01). No significant difference was found in the number of swallows when comparing cisapride with lozenge.


CONCLUSIONS
Cholinergic stimulation of salivation is an effective means of facilitating oesophageal acid clearance. Drugs, such as 5 hydroxytriptamine (5-HT)4-receptor agonists, should be considered as potentially important compounds in the treatment of gastro-oesophageal reflux disease.
Orr
W C
WC
Lynn Institute for Health Care Research, Oklahoma City, OK 73112, USA.
Chen
C L
CL
Sloan
S
S
D000368:Aged; D000375:Aging; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D020117:Cisapride / Q000627:therapeutic use*; D003679:Deglutition / Q000187:drug effects; D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D006801:Humans; D006851:Hydrochloric Acid / Q000493:pharmacokinetics*; D006863:Hydrogen-Ion Concentration / Q000187:drug effects; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D012472:Salivation / Q000187:drug effects*
D000897:Anti-Ulcer Agents; D006851:Hydrochloric Acid; D020117:Cisapride