Prokinetics and reflux: a promise unfulfilled.
Gastro-oesophageal reflux disease (GORD) has been described as a motility disorder of the upper gastrointestinal tract. Disturbances of lower oesophageal sphincter function, lower oesophageal body motility, oesophageal clearance and gastric emptying are well accepted. Cisapride improves most of these but its clinical benefits have been relatively modest. Some recent studies have indicated that the improvements achieved with cisapride may be less marked than originally thought. Furthermore, the agent has no effect on transient lower oesophageal sphincter relaxations, nor on other important factors influencing gastro-oesophageal junction competence, such as the external sphincter function of the diaphragmatic crus and mechanical influences such as lower oesophageal sphincter length exposed to intra-abdominal pressure changes. More potent, specific and predictable prokinetic agents would be welcome, but are unlikely to be effective as single agents across the range of GORD. There is certainly a need for such agents, including cisapride, as adjuncts to acid suppression in patients who fail to respond to the latter.
de Caestecker
John
J
Department of Gastroenterology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK. john.decaestecker@uhl-tr.nhs.uk
D020117:Cisapride / Q000494:pharmacology / Q000627:therapeutic use*; D004943:Esophagogastric Junction / Q000187:drug effects; D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D005765:Gastrointestinal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D017366:Serotonin Receptor Agonists / Q000494:pharmacology / Q000627:therapeutic use*
D005765:Gastrointestinal Agents; D017366:Serotonin Receptor Agonists; D020117:Cisapride