Effect of tegaserod on esophageal pain threshold, regurgitation, and symptom relief in patients with functional heartburn and mechanical sensitivity.
OBJECTIVE
Tegaserod, a 5-HT4-receptor partial agonist, effectively treats irritable bowel syndrome with constipation. The role of tegaserod in functional disorders of the upper gastrointestinal (GI) tract is unclear. The aims of this study were to determine if tegaserod improves esophageal pain with mechanical and chemical stimuli, GI symptom profile, and global preference in patients with functional heartburn.


METHODS
Patients with functional heartburn, as defined by Rome II criteria, underwent esophageal barostat and acid-infusion sensory tests. Mechanical hypersensitivity was required for entry. The baseline GI symptom profile was rated before treatment. Patients were blinded to treatment and randomly assigned to tegaserod 6 mg twice daily or placebo for 14 days, and crossed-over to the alternate treatment after 7 to 10 days of washout. Patients underwent sensory tests and rated GI symptoms after each treatment. Global treatment preference was completed at the end of the study.


RESULTS
Forty-two patients (15 men, 27 women; age, 20-68 y) completed the study. The predominant baseline symptoms in addition to heartburn included upper-abdominal pain, upper-abdominal discomfort, regurgitation, chest pain, early satiety, and postmeal bloating. Tegaserod significantly increased balloon pressure to pain (P = .04) and the mean (P = .002) and maximum wall tension at pain (P = .0004). Tegaserod did not alter pain with acid infusion. Tegaserod significantly decreased the frequency of occurrence of heartburn/acid reflux (P = .004), regurgitation (P = .048), and distress from regurgitation (P = .039). The global preference for tegaserod was 63.4% vs 12.2% for placebo.


CONCLUSIONS
Tegaserod improved the esophageal pain threshold to mechanical distention, and distressing upper-GI symptoms in patients with functional heartburn.
Rodriguez-Stanley
Sheila
S
Oklahoma Foundation for Digestive Research, Oklahoma City, Oklahoma, USA. sheila-stanley@ouhsc.edu
Zubaidi
Sattar
S
Proskin
Howard M
HM
Kralstein
Jeffrey R
JR
Shetzline
Michael A
MA
Miner
Philip B
PB
D000328:Adult; D000368:Aged; D003187:Compliance / Q000187:drug effects; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004947:Esophagus / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy*; D005765:Gastrointestinal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006356:Heartburn / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007211:Indoles / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017288:Pain Threshold / Q000187:drug effects*; D017060:Patient Satisfaction; D012720:Severity of Illness Index; D016896:Treatment Outcome
D005765:Gastrointestinal Agents; D007211:Indoles; C105050:tegaserod