Does the use of nizatidine, as a pro-kinetic agent, improve gastric emptying in patients post-oesophagectomy?
OBJECTIVE
Delayed gastric emptying following oesophagectomy is common and can often lead to weight loss, malnutrition and a poor quality of life. Animal models have shown that nizatidine, a histamine H2-receptor antagonist, has pro-kinetic properties and can accelerate gastric emptying. Patients post-oesophagectomy require long-term acid suppression medication; if nizatidine can improve gastric emptying, it can be adopted for its dual pharmacological actions.


METHODS
Twenty consecutive patients were prospectively enrolled in this trial following oesophagectomy. All patients were more than 6 months post-surgery and had no evidence of recurrent cancer. A baseline nuclear medicine scan following a radiolabelled meal was conducted and then repeated after 1 week of nizatidine (150 mg bd) treatment. Quality of life and eating comfort data were collected.


RESULTS
Oesophagectomy causes a significant delay in gastric emptying. Early satiety (80%) and reflux (65%) were the most common post-operative complaints. The percentage of food remaining in the stomach at 60 min post-meal was significantly more than normal values in both the pre- and post-nizatidine studies. There is no advantage in using nizatidine as a pro-kinetic agent.


CONCLUSIONS
Impaired gastric emptying post-surgery causes a change in eating habits. Patients in this study did not lose a significant amount of weight despite all indicating worse eating comfort. Patients required more regular meals or snacks throughout the day and avoid foods that are difficult to swallow. It is likely that gastric motility only plays a small role in the emptying process and gravity combined with appropriate drainage procedures (pyloroplasty/pyloromyotomy) at the time of surgery are more important.
Simpson
Paul J
PJ
Department of Surgery, Cabrini Hospital, 183 Wattletree Rd, Malvern, Victoria 3144, Australia. drpauljs@bigpond.net.au
Ooi
Corinne
C
Chong
Jennifer
J
Smith
Andrew
A
Baldey
Andrew
A
Staples
Margaret
M
Woods
Simon
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D004935:Esophageal Diseases / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D005746:Gastric Emptying / Q000502:physiology*; D018589:Gastroparesis / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016567:Nizatidine / Q000627:therapeutic use*; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D016567:Nizatidine