Does the addition of a prokinetic to proton pump inhibitor therapy help reduce duodenogastro-oesophageal reflux in patients with Barrett's oesophagus?
OBJECTIVE
The metaplastic change of Barrett's oesophagus is linked to both acid and duodenal reflux together with impaired motility. Proton pump inhibitors (PPI) reduce acid reflux, but no treatment is available that reduces duodenogastro-oesophageal reflux (DGOR). The aim of this study was to investigate whether adding a prokinetic to PPI treatment could improve oesophageal motility and subsequently reduce reflux.


METHODS
Two groups of patients with Barrett's oesophagus on PPI therapy (prokinetic, n = 12; placebo, n = 11) were investigated. At visit 1, ambulatory oesophageal manometry was performed, and peristaltic and simultaneous wave percentage and characteristics were measured. DGOR and pH measurements were also performed. After treatment with either the prokinetic cisapride or placebo, all investigations were repeated (visit 2). Analysis of covariance and Spearman's correlation coefficients of changes from visit 1 to visit 2 were used to compare data.


RESULTS
There was no significant difference between the two groups with respect to DGOR, DGOR characteristics, or the percentage of peristalsis and simultaneous waves and their characteristics. There was no correlation between DGOR and motility changes. Although no significant differences existed between acid reflux in the two groups, five patients with high supine acid reflux showed a significant reduction after treatment with cisapride.


CONCLUSIONS
Addition of cisapride to PPI treatment does not appear to improve oesophageal motility or reduce DGOR in patients with Barrett's oesophagus.
Smythe
Anne
A
Academic Surgical Unit, University of Sheffield, UK. a.smythe@sheffield.ac.uk
Bird
Nigel C
NC
Troy
Gill P
GP
Ackroyd
Roger
R
Johnson
Alan G
AG
D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001471:Barrett Esophagus / Q000188:drug therapy* / Q000209:etiology; D020117:Cisapride / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004383:Duodenogastric Reflux / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy*; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D006863:Hydrogen-Ion Concentration / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D010528:Peristalsis / Q000187:drug effects; D054328:Proton Pump Inhibitors
D000897:Anti-Ulcer Agents; D005765:Gastrointestinal Agents; D054328:Proton Pump Inhibitors; D020117:Cisapride