piperidines and Dyspepsia

Dyspepsia is most optimally defined as pain or discomfort centred in the upper abdomen. The symptom complex may be caused by peptic ulcer disease, gastro-oesophageal reflux, or gastric cancer but is most often due to functional (or non-ulcer) dyspepsia. While upper endoscopy is the method of choice to determine the underlying cause of dyspepsia, it is expensive. A more pragmatic approach is needed in the Asia Pacific region where health services are limited. A detailed treatment algorithm is given for managing patients presenting with new-onset dyspepsia and documented functional dyspepsia after endoscopy, and evidence to support this approach is reviewed. Prompt endoscopy is recommended for patients with alarm features. In patients without alarm features, treatment for 2-4 weeks with an empirical anti-secretory or prokinetic agent, followed by investigation using non-invasive Helicobacter pylori testing and treatment for patients who do not respond or relapse, is recommended. Trials of management strategies are now needed to establish the efficacy and cost-effectiveness of the approaches recommended.

Topics: Antiemetics; Asia; Cisapride; Disease Management; Domperidone; Dyspepsia; Endoscopy; Gastrointestinal Agents; Helicobacter Infections; Histamine H2 Antagonists; Humans; Pacific Islands; Piperidines

Dyspepsia affects one in four Australians; of those who present in general practice, the majority will have functional or non-ulcer dyspepsia, with no structural explanation for their symptoms. Older patients who present for the first time with dyspepsia, and those with 'alarm features' deserve immediate investigation (preferably by upper endoscopy), to exclude cancer, peptic ulcer or oesophagitis. Other patients may be given empiric therapy (for example, a prokinetic or H2 blocker) initially, but require investigation if this fails. The role of Helicobacter pylori infection in functional dyspepsia is uncertain.

Topics: Adult; Aged; Antacids; Anti-Inflammatory Agents, Non-Steroidal; Anti-Ulcer Agents; Bismuth; Child; Cholelithiasis; Chronic Disease; Cisapride; Diagnosis, Differential; Domperidone; Dopamine Antagonists; Dyspepsia; Gastroesophageal Reflux; Helicobacter Infections; Helicobacter pylori; Histamine H2 Antagonists; Humans; Metoclopramide; Peptic Ulcer; Piperidines; Stomach Neoplasms

In the treatment of gastrointestinal motility disorders 3 prokinetic agents are principally available. They are differentiated from their pharmacological mode of action, their clinical efficacy and tolerability. Metroclopramide is an antidopaminergic benzamide with mainly antiemetic effects and minor prokinetic efficacy in the GI-Tract. Domperidon is a pure dopaminantagonist. It accelerates gastric emptying but has less effect on bowel motility. Cisapride stimulates indirect the secretion of acetylcholine and acts via 5 HT-receptors selective at the plexus myentericus. These pharmacological differences have clinical relevance: metoclopramide and domperidon could not consistently prove efficacy in functional dyspepsia and GORD. In addition the data in other indications are rare. Only cisapride has shown significant responder rates in controlled studies in the treatment of gastrointestinal motility disorders particularly in long term treatment. As concerns tolerability cisapride presents a progress by its selective mode of action in contrast to the agents crossing the blood-brain-barrier.

Topics: Adult; Antiemetics; Child; Cisapride; Clinical Trials as Topic; Domperidone; Dopamine Antagonists; Dyspepsia; Gastric Emptying; Gastroesophageal Reflux; Gastrointestinal Motility; Humans; Metoclopramide; Piperidines; Postoperative Complications; Serotonin Receptor Agonists; Treatment Outcome

Topics: Antacids; Anti-Ulcer Agents; Cisapride; Diagnosis, Differential; Dopamine Antagonists; Dyspepsia; Histamine H2 Antagonists; Humans; Middle Aged; Piperidines; Serotonin Antagonists; Syndrome; Terminology as Topic

To summarize the pharmacology, pharmacokinetics, efficacy, and safety of cisapride, and to evaluate its potential therapeutic role.. A computerized search of the MEDLINE database was used to identify English-language publications of cisapride data in humans. The MEDLINE search was supplemented by review article bibliographies. There was no attempt to limit the search to a specific gastrointestinal motility disorder.. The MEDLINE search alone identified 165 citations. Because of the volume of available human cisapride data, the focus of the efficacy section is on complete published reports of controlled clinical studies. Abstracts and uncontrolled data are discussed only when other information is unavailable to address important aspects.. Information regarding study design, study population, results, and safety was recorded from each publication. The placebo response to gastrointestinal complaints in patients with motility disorders is high. Therefore, objective evidence of improvement was emphasized when documentation was available.. Cisapride stimulates the motility of smooth muscle lining the esophagus, stomach, small intestine, and colon, and increases the tone of gut sphincters in vitro and in vivo. In controlled investigations, cisapride was superior to placebo in relieving symptoms associated with reflux esophagitis, nonulcer dyspepsia, and gastroparesis. Similar symptom and healing effects were observed with cisapride and histamine (H)2-antagonists in reflux esophagitis. Cisapride was either equal to or superior to metoclopramide in relieving reflux symptoms. However, metoclopramide was associated with significantly more central nervous system adverse effects. Cisapride was well tolerated, with adverse effects limited primarily to the gastrointestinal tract.. Cisapride represents an attractive alternative to metoclopramide for the treatment of a variety of motility disorders. Because it addresses a primary underlying cause of reflux esophagitis, cisapride may also prove to be an effective alternative to acid suppressants in the management of this disorder.

Topics: Adult; Anti-Ulcer Agents; Cisapride; Clinical Trials as Topic; Constipation; Double-Blind Method; Dyspepsia; Gastroesophageal Reflux; Gastrointestinal Motility; Humans; Infant; Infant, Newborn; Parasympathomimetics; Piperidines

Symptoms of functional dyspepsia are frequent; the prevalence of dyspepsia (defined as pain or discomfort centred in the upper abdomen) in the general population approaches 25%. By definition, patients with functional dyspepsia do not have a structural or biochemical explanation for their symptoms. Disorders of function (e.g. delayed gastric emptying) are detectable in a proportion of patients but remain poorly understood. Nevertheless, the current rationale for drug treatment is based on altering pathophysiological mechanisms which are believed to be associated with the development of symptoms. Although the placebo response rates approach 60%, prokinetics, acid-suppressing agents and bismuth-containing compounds have been shown to be significantly better than placebo in reducing symptoms. Antacids are widely used, but no controlled study has been able to demonstrate a significant benefit over placebo. The efficacy of sucralfate is uncertain. Rational guidelines on which drug should be used for a given patient are lacking, although approaches based on symptom profiles have been proposed; the duration of treatment needed to achieve long-lasting relief of symptoms is also poorly defined. Identifying optimal treatment for the individual patient, therefore, continues to be largely a trial and error process. Further research efforts are needed to elucidate the pathophysiological basis of functional dyspepsia so that specific therapy can be tailored to underlying pathophysiological disturbances.

Topics: Cisapride; Dopamine Antagonists; Dyspepsia; Gastric Acid; Gastrointestinal Agents; Gastrointestinal Motility; Helicobacter Infections; Helicobacter pylori; Histamine H2 Antagonists; Humans; Piperidines; Randomized Controlled Trials as Topic; Serotonin Antagonists

Disorders of gastric emptying are observed in many clinical situations. Their symptoms are diverse and correlate poorly with the objective abnormalities of gastric emptying. The underlying mechanism consists of abnormalities of basal electrical rhythm, fundic compliance, post-prandial antral motricity and, above all, antro-pyloro-duodenal co-ordination, associated to varying degrees. Among possible causes 3 clinical situations predominate: diabetes mellitus, functional gastrointestinal disorders (idiopathic dyspepsia) and sequelae of gastric surgery where retention of solids and accelerated evacuation of liquids may coexist in the same patient. Treatment of gastric incontinence rests, almost exclusively, on dietary measures, but several drugs, such as metoclopramide, domperidone and cisapride, are available to treat gastric stasis. Other compounds, notably motilin agonists (erythromycin and its derivatives) are currently being evaluated and will reinforce this therapeutic armentarium in a not too distant future.

Topics: Cisapride; Diabetes Complications; Domperidone; Dyspepsia; Gastric Emptying; Gastroesophageal Reflux; Humans; Metoclopramide; Piperidines; Postoperative Complications; Serotonin Antagonists; Stomach Diseases; Stomach Ulcer

Motility-like dyspepsia, a clinical subgroup of functional dyspepsia, refers to the cluster of symptoms which suggests an underlying motility disturbance of the upper gut. Characteristic symptoms, in addition to upper abdominal pain or discomfort, are nausea, vomiting, early satiety, anorexia, postprandial abdominal bloating and excessive repetitive postprandial belching. Patients with concomitant symptoms of irritable bowel syndrome are currently excluded from this clinical entity. Delayed gastric emptying of solids and/or liquids, postprandial antral hypomotility and antroduodenal incoordination, gastric myoelectrical arrhythmias and dysfunction of visceral afferents are the major alterations in upper gut sensorimotor activity which have been described. An empirical trial of medical therapy is warranted if there are no "alarm" symptoms at presentation. If symptoms are not relieved after 2-4 weeks, then investigations of the upper gastrointestinal tract, preferably by endoscopy, to exclude the presence of organic disease, is advisable. Management approaches are then reassurance, dietary manipulations and attention to psychosocial aspects. Prokinetic agents appear to be useful as short-term medical therapy in some patients, but optimum long-term treatment strategies, including the use of medications which may improve a diminished tolerance to gut distension, are not established.

Topics: Cisapride; Dyspepsia; Gastric Emptying; Gastrointestinal Agents; Gastrointestinal Motility; Humans; Piperidines; Serotonin Antagonists

Topics: Cisapride; Dyspepsia; Gastroesophageal Reflux; Gastrointestinal Motility; Humans; Metoclopramide; Piperidines

The authors describe the gastro-kinetic drugs that act on functional dyspepsia including metoclopramide, domperidone, clebopride cisapride. Moreover, in some forms of non-ulcer dyspepsia it is useful to give sulglicotide, a cytoprotective drug that has been shown to induce marked improvement of clinical symptoms and endoscopic findings.

Topics: Animals; Anti-Ulcer Agents; Antiemetics; Benzamides; Cisapride; Domperidone; Dyspepsia; Humans; Metoclopramide; Piperidines; Serotonin Antagonists; Sialoglycoproteins

Topics: Cisapride; Duodenum; Dyspepsia; Gastrointestinal Motility; Humans; Metoclopramide; Piperidines; Pyloric Antrum; Serotonin Antagonists; Terminology as Topic

Topics: Cisapride; Dose-Response Relationship, Drug; Double-Blind Method; Dyspepsia; Humans; Multicenter Studies as Topic; Piperidines; Randomized Controlled Trials as Topic; Serotonin Antagonists

Topics: Cisapride; Constipation; Dyspepsia; Esophagitis; Esophagus; Forecasting; Gastric Emptying; Gastroesophageal Reflux; Gastrointestinal Motility; Humans; Hydrogen-Ion Concentration; Intestinal Pseudo-Obstruction; Intestines; Manometry; Piperidines; Serotonin Antagonists; Stomach

Five studies have shown that cisapride increased the antral motility index in the interdigestive and digestive states and three of these studies showed a stimulation of duodenal motility index and increased antroduodenal coordination. In normal volunteers and in patients with dyspepsia (223 subjects), both solid and liquid emptying is speeded by cisapride compared with placebo, and cisapride was as good as, or better than, metoclopramide at the same dosage. In studies in 37 diabetics with gastroparesis, both solid and liquid emptying were speeded and returned to normal, and cisapride was superior to metoclopramide. Solid emptying was speeded in patients with anorexia nervosa, chronic pseudo-obstruction and systemic sclerosis and the delay in gastric emptying induced by both morphine and dopamine was reversed. The effect of cisapride on bile reflux is still uncertain. Eight different methods of measuring gastric emptying were employed in these studies and they all gave similar results; the doses ranged from 2.5-10 mg i.v., and up to 20 mg orally.

Topics: Cisapride; Dyspepsia; Gastric Emptying; Gastrointestinal Motility; Humans; Piperidines; Postoperative Complications; Serotonin Antagonists

Non-ulcer dyspepsia is gaining increasing interest among gastroenterologists even though the pathogenetic mechanisms in individual patients are still unknown. On the basis of a number of studies, it can be concluded that in about 60% of patients impairment of gastric evacuation may contribute to the symptomatology (epigastric pain, postprandial fullness, early satiety, bloating, nausea and vomiting). This review summarizes the results of 10 placebo-controlled trials which evaluated the effects of cisapride (3 x 5 or 3 x 10 mg/day) in strict non-ulcer dyspepsia or functional postprandial dyspepsia. In seven of the trials, cisapride proved significantly superior to placebo in relieving epigastric pain and concomitant symptoms in patients with non-ulcer dyspepsia. In the three studies examining chronic functional dyspepsia, belching, postprandial bloating, early satiety and heartburn were significantly improved. In all 10 trials, cisapride was significantly superior to placebo.

Topics: Cisapride; Clinical Trials as Topic; Double-Blind Method; Dyspepsia; Humans; Piperidines; Serotonin Antagonists

Even with the most effective treatment, Helicobacter pylori eradication is difficult in some patients. Therefore, patients sometimes require acid-suppressive therapy without H. pylori eradication. It has been reported that ranitidine inhibits neutrophil activation, whereas famotidine does not. However, few studies have been published concerning the activation of neutrophils before and after treatment using clinical doses of histamine-2 receptor antagonists in patients with H. pylori infection.. To examine the effects of neutrophil activation after treatment with three different histamine-2 receptor antagonists.. This prospective, open-label, randomised, parallel-group study was conducted. Thirty patients with H. pylori infection were enrolled. These subjects were randomly assigned to receive one of the following treatments: (a) 150 mg ranitidine, (b) 20mg famotidine, or (c) 10 mg lafutidine b.d., for 4 weeks. Before and after histamine-2 receptor antagonist treatment, histological findings, myeloperoxidase activity, and interleukin-8 in the gastric mucosa were evaluated.. On the basis of the histological findings between before and after histamine-2 receptor antagonist treatment, no significant differences were found in any groups. Similarly, there were no significant differences in myeloperoxidase activity or interleukin-8 levels.. In patients with H. pylori, when used at clinical doses, any histamine-2 receptor antagonists can be used without concerning about inhibition of neutrophil activation.

Topics: Acetamides; Adult; Dyspepsia; Famotidine; Female; Helicobacter Infections; Helicobacter pylori; Histamine H2 Antagonists; Humans; Interleukin-8; Male; Middle Aged; Neutrophil Activation; Peroxidase; Piperidines; Pyridines; Ranitidine

Disordered autonomic nerve function is frequently present in patients with functional dyspepsia (FD). In this study we investigated whether the prokinetic cisapride, which acts via acetylcholine receptors, and stress may modulate these abnormalities.. Nineteen patients (6 men, 13 women) with FD and 10 healthy subjects (3 men, 7 women) were studied after 3 days' treatment with 10 mg cisapride three times daily and placebo in a crossover design. Mental stress was induced with a videogame. Sympathetic and vagal nerve functions were assessed noninvasively by skin conductance and respiratory sinus arrhythmia, respectively.. Vagal tone was significantly lower in FD patients than in controls both before and after mental stress (P < 0.001). Sympathetic tone was higher in patients with FD than in controls (P < 0.03). Generally, stress scores were increased by mental stress in both groups (P < 0.001). In FD patients, but not in controls, cisapride significantly increased the sympathetic tone both before (P < 0.05) and after stress (P < 0.05).. Patients with FD have lower vagal tone and higher sympathetic tone than healthy controls. Treatment with cisapride increased sympathetic tone in the patient group but had no effect on vagal tone.

Topics: Adult; Autonomic Pathways; Cisapride; Cross-Over Studies; Double-Blind Method; Dyspepsia; Female; Hemodynamics; Humans; Male; Middle Aged; Parasympathomimetics; Piperidines; Skin Physiological Phenomena; Stomach; Stress, Psychological; Vagus Nerve

Patients in most trials of pharmacotherapy for nonorganic dyspepsia have been groups referred selectively for endoscopy, which could have led to a selection bias of nonresponders, explaining the negative outcome of most controlled treatment trials in nonorganic dyspepsia. The aim of this study was to evaluate the effects of cisapride and nizatidine in patients with nonorganic dyspepsia who were recruited directly from primary care settings, and to evaluate the therapeutic implications of dyspepsia subgrouping.. A consecutive series of patients who consulted their general practitioner with dyspepsia were invited to an interview and endoscopy. Before endoscopy, symptoms were classified as reflux-like, dysmotility-like, ulcer-like, or unclassifiable. A total of 330 patients with either minor or no abnormalities at endoscopy were randomized to double blind treatment with cisapride 10 mg t.i.d., nizatidine 300 mg at night, or placebo for 2 wk.. A symptomatic response was found in 62% of patients on cisapride (therapeutic gain cisapride vs placebo: 0.1% [95% confidence interval -14% to 14%]) and in 54% of patients on nizatidine (therapeutic gain nizatidine vs placebo: -8% [95% confidence interval -22% to 7%]). Response to treatment was independent of symptom classification.. The effects of a 2-wk course of cisapride or nizatidine in unselected patients with dyspepsia recruited from primary care were not superior to those of placebo. Symptom subgrouping was not predictive of response to therapy.

Topics: Adult; Anti-Ulcer Agents; Cisapride; Double-Blind Method; Dyspepsia; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nizatidine; Piperidines; Predictive Value of Tests; Time Factors; Treatment Outcome

Functional dyspepsia is recognized as a common disorder in clinical practice. The aim of this study was to determine the efficacy and adverse effects of cisapride compared to a placebo in patients from a general practice with functional dyspepsia (FD). Secondly we investigated whether Helicobacter pylori-positive FD patients present with specific symptoms and determined the efficacy of cisapride for FD patients with H. pylori.. In a placebo-controlled double-blind study, patients were randomized to receive fixed doses of either cisapride (10 mg three times daily) or placebo. Symptoms were evaluated after 2 and 4 weeks of treatment. The selection of FD patients,collection of data, and evaluation of symptoms as well as adverse effects were performed by general practitioners. Dyspeptic patients were referred to the Gastroenterology Department in order to exclude ulcers, oesophagitis, pancreatitis and gallstones. Biopsies of gastric mucosa were taken for histological examination and H. pylori culture.. 121 patients entered this study (61 took cisapride, 60 placebo). There were 113 patients (56 cisapride, 57 placebo) available for analysis of the efficacy and 120 patients (61 cisapride, 59 placebo) for evaluation of adverse effects.In total 102 biopsies were tested for the presence of gastritis by histological examination. There were 30 H. pylori-positive cultures among 111 patients.. After 4 weeks a statistically significant reduction in symptoms was found, but it was similar in the two groups. No symptoms specific for H. pylori-positive patients were found. There was not a significant difference in the response to cisapride between H. pylori-positive and H. pylori-negative patients. The difference in overall (63%) response in the cisapride group and the 44% response in the placebo group did not reach statistical significance.. No significant difference was found between placebo and cisapride in the treatment of FD in general practice. H. pylori-positive patients did not present with specific symptoms nor did they exhibit a different response to cisapride.

Topics: Adolescent; Adult; Aged; Anti-Ulcer Agents; Cisapride; Diagnosis, Differential; Double-Blind Method; Dyspepsia; Family Practice; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Piperidines

In the present double-blind placebo-controlled study the effect of cisapride on functional dyspepsia was evaluated in patients with and without histological gastritis. Patients with functional dyspepsia and whose symptoms persisted after a 2 week run-in period with antacid treatment were randomized to receive cisapride (10 mg) or matching placebo three times daily for 4 weeks. Symptoms of epigastric pain, bloating, nausea, belching, early satiety and heartburn were graded on a four-point scale based on patients' feedback and diary card recording. A global response was also formulated by the investigators. One hundred and four patients entered the study and 76 completed the trial, comprising 36 patients with histological gastritis and 40 patients without gastritis. Symptom scores in both gastritis and non-gastritis groups were significantly improved by both cisapride and placebo; however, the improvement was not statistically different between the two treatment groups. Cisapride produced a good or better global response in 58% of subjects with histological gastritis and in 53% of subjects without gastritis compared with 47% and 52%, respectively, of patients on placebo; this difference was not statistically significant. Gastric histology did not influence the effect of cisapride on the symptoms of functional dyspepsia.

Topics: Adult; Anti-Ulcer Agents; Cisapride; Double-Blind Method; Dyspepsia; Female; Gastric Mucosa; Gastritis; Humans; Male; Middle Aged; Piperidines

Cisapride is a substituted benzamide with gastrointestinal prokinetic effects presumed to be due to the enhancement of the physiological release of acetylcholine at the myenteric plexus. In a multicentre study, 189 patients with nonulcer dyspepsia (NUD) received single-blind placebo treatment for two weeks. A total of 123 patients with no or minimal response to placebo and epigastric pain of at least moderate severity and frequency were randomly assigned to one of the three parallel double-blind treatments for six weeks: cisapride 10 mg tid, cisapride 20 mg tid or placebo. The severity and frequency of individual symptoms (epigastric pain, heartburn, nausea, vomiting anorexia, postprandial discomfort, regurgitation, lower abdominal pain, bloating and constipation) were assessed on a four- and five-point categorical scale, respectively, by the investigator at three on treatment visits and by patients in a daily diary. Analysis of investigator and patient assessments for differences in symptom severity x frequency composite scores among the three treatment groups showed no statistically significant differences for individual symptoms or symptom clusters. As assessed by the investigator, and compared with baseline, cisapride 20 mg tid significantly (P < 0.05) improved epigastric pain, bloating and early satiety as well as improved the total symptom cluster. Investigator evaluation of the five most severe and frequent symptoms for each patient showed statistically significant improvement in each treatment group. For patient diary assessments, statistically significant within-treatment improvement of the total symptom cluster, the five most severe symptoms cluster, bloating and early satiety was observed for both cisapride 20 mg and placebo, whereas epigastric pain significantly (P < 0.05) improved in all three treatment groups. Investigator evaluation of global response (good+excellent) rate at the end of the six week treatment period was 38% for cisapride 20 mg, 47% for cisapride 10 mg and 33% for placebo. No statistically significant difference in this parameter among treatments was noted. Cisapride was well tolerated at both doses with a side effect profile comparable with that of placebo. It is concluded that in this double-blind multicentre study with a single-blind two-week placebo run in phase, cisapride 10 mg tid and 20 mg tid were not effective compared with placebo in improving symptoms in NUD patients. This study re-emphasizes the good prognosis of

Topics: Administration, Oral; Adult; Analysis of Variance; Anti-Ulcer Agents; Cisapride; Dose-Response Relationship, Drug; Double-Blind Method; Dyspepsia; Female; Humans; Male; Piperidines; Treatment Outcome

In dyspepsia few data are available from the primary care setting on how selective, risk-factor-oriented endoscopy compares with mandatory endoscopy in the diagnostic outcome and in direct and secondary costs. We studied this in a two-armed multicentre trial (omega-project) with primary care physicians.. Patients were enrolled and treated by primary care physicians and referred to a gastroenterologist for upper gastrointestinal endoscopy (UGE). Patients were enrolled in the study if they had had epigastric complaints for more than 1 month and no obvious signs or history of organic disease. In the first arm of the study endoscopy was mandatory, in the second selective, i.e. according to a predefined risk profile. Patients enrolled were treated with prokinetic drugs for 2 months. A further indication for endoscopy was non-response to treatment (reduction of the initial symptoms score by less than two-thirds) in the study with selective endoscopy and relapse within the 2-month follow-up period in both studies. The direct costs from number of consultations with the primary care physician, UGEs, number of prescriptions per patient and also absenteeism in days per week were carefully registered in both groups.. All 172 patients of the mandatory endoscopy study and 203/656 patients enrolled in the selective endoscopy study had an UGE (125 at admission, 78 in the follow-up period). Patients were treated for 4 weeks (cisapride or domperidone) and thereafter followed for 8 weeks, at the end of the observation period the response rates were 80% and 79%, respectively. The prevalence of gastric cancers was similar in both groups (> 1%) but extrapolation from the data collected with compulsory endoscopy suggests that two-fifths of the anticipated peptic lesions remained undetected by following the selective strategy. The cost analysis revealed a 31% cost reduction with the selective strategy--in the Swiss cost system--through a reduction in the number of endoscopies by 67%.. Selective UGE is cheaper and appears not to compromise the response to prokinetics; however, its diagnostic power is less than with mandatory UGE.

Topics: Adult; Cisapride; Costs and Cost Analysis; Domperidone; Dopamine Antagonists; Double-Blind Method; Dyspepsia; Endoscopy, Digestive System; Female; Follow-Up Studies; Gastrointestinal Diseases; Humans; Male; Mandatory Testing; Middle Aged; Parasympathomimetics; Piperidines; Prospective Studies; Recurrence

The HT4-agonist Cisapride (CIS) and the peripheral D2-antagonist Domperidone (DOMP) have distinct prokinetic actions. We compared their clinical efficacy in 127 dyspeptic patients. Patients with upper abdominal complaints of > 1 month duration, who had a normal UGE were allocated to the REFLUX-group (RG), (predominance of heartburn, acid regurgitation or retrosternal pain) or if devoid of this specific symptomatology to the DYSPEPSIA-group (DG) In a double-blind randomised fashion and allocated to 10 mg CIS or 20 mg DOMP qid (RG) or tid (DG) for 1 month and followed-up for further 2 months. In RG (N = 43, p < 0.05) the response rates were clearly in favour of CIS, but not in DG (N = 84). In RG DOMP was more effective against nausea. The benefit of both therapies was largely maintained in the follow-up period. Cisapride and domperidone were effective in the treatment of dyspepsia. Cisapride was more effective than domperidone in the REFLUX-Group.

Topics: Adult; Anti-Ulcer Agents; Cisapride; Domperidone; Double-Blind Method; Dyspepsia; Female; Follow-Up Studies; Gastroesophageal Reflux; Gastrointestinal Agents; Humans; Male; Middle Aged; Piperidines; Treatment Outcome

Intestinal dysmotility is commonly reported in patients with cystic fibrosis (CF); however, gastric motor activity has rarely been investigated. We measured with real-time ultrasonography the antral distention and gastric emptying time of a solid-liquid meal in 29 patients with CF (age range, 5 to 17 years). A significantly prolonged gastric emptying time was present in 26 patients compared with 13 healthy control subjects (age range, 5 to 16 years); an exaggerated antral distention in the fed period was also detected. The patients with CF and delayed gastric emptying were randomly allocated to receive cisapride or ranitidine for 4 weeks. Twelve patients treated with ranitidine and 11 with cisapride completed the trial. There was a marked decrease in gastric emptying time, antral distention, and dyspeptic symptomatic score in patients receiving ranitidine but not in patients treated with cisapride. We conclude that gastric dysmotility is commonly detected in patients with CF and that H2 receptor blockers are more effective than prokinetics in improving dyspeptic symptoms and gastric emptying and distention.

Topics: Adolescent; Child; Child, Preschool; Cisapride; Cystic Fibrosis; Dyspepsia; Female; Gastric Emptying; Histamine H2 Antagonists; Humans; Male; Piperidines; Pyloric Antrum; Ranitidine; Ultrasonography

Disordered gastric antral motor activity may be induced by mental stress. The effect of cisapride on these abnormalities has previously not been investigated.. Ten healthy subjects and 19 patients with functional dyspepsia (FD) and erosive prepyloric changes participated in the study. Antral motility was recorded with real-time ultrasonography after ingestion of 500 ml meat soup during i) a 4-min rest period, ii) 2.5 min of mental stress, and iii) a 4-min recovery period. Patients and controls were studied after 3 days of treatment with 10 mg cisapride three times daily and placebo in a double-blind crossover design.. Mean postprandial amplitude of antral contractions was lower in patients than controls (p < 0.001). Antral amplitude was reduced by mental stress in healthy persons (p < 0.001) but not in patients. Both fasting and postprandial antral areas were larger in FD patients than controls (p < 0.001 and p = 0.02, respectively). Cisapride reduced the fasting (p < 0.001) and the postprandial (p = 0.05) antral area in the FD group but not in controls. The soup meal produced dyspeptic symptoms in 90% of the patients and in only 10% of the controls (p < 0.001). Cisapride had no significant effect on symptoms or antral contractions.. Mental stress induced antral hypomotility in healthy subjects but not in patients with FD who had reduced motility at base line. Cisapride reduced the enlarged fasting and postprandial antral areas in the patients but had no effect on amplitudes of antral contractions or symptoms.

Topics: Cisapride; Cross-Over Studies; Double-Blind Method; Dyspepsia; Female; Gastrointestinal Motility; Humans; Male; Middle Aged; Piperidines; Pyloric Antrum; Stress, Psychological; Ultrasonography

Little is known about the prescribing habits and impact of life style or disease factors on the outcome of cisapride treatment for dyspepsia in primary care.. In this large-scale open, multi-centre study in Austria, primary care physicians were asked to prescribe cisapride according to the current prescribing guidelines (standard dose, 5 mg t.d.s.; in case of severe symptoms, 10 mg t.d.s.). Symptom severity was rated by the physicians, after 4 weeks of treatment and after another 4 weeks of follow-up without medication. The global therapeutic result was given by both the physicians and patients.. Among the 3912 recruited patients, 60.0% received cisapride 5 mg t.d.s. and 38.5% received 10 mg t.d.s. The dose selection by the physicians was not only influenced by severity of the symptoms (significantly more patients with severe symptoms receiving the higher dosage when compared to those with milder symptoms (P < 0.001), but also other factors were associated with prescription of the higher dose: including heavy smoking, longer pre-existence of complaints and failing previous treatment. After 4 weeks of treatment, the dyspeptic symptoms improved in about 80% of patients, in both dosage groups. Four weeks after discontinuation of medication, 21% of patients still further improved, while 10% relapsed. The overall therapeutic outcome defined as the percentage of patients with good or excellent results was comparable in both dosage groups and appeared independent of the patient's characteristics, life style or disease factors. However, when only the proportion of "excellent' responders was analysed, this rate significantly decreased the longer the duration of symptoms, the heavier the smoking and with failing previous therapy. This effect was particularly seen with the patients' ratings.. Although the open-study design does not allow evaluation of the contribution of placebo-effect and calls for cautious interpretation, the data suggest that the use of flexible cisapride doses for management of dyspepsia in primary care results in a good acute and medium-term outcome, with apparently little dependence on life style and disease factors, at least when assessed by physicians.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Ulcer Agents; Child; Child, Preschool; Cisapride; Dyspepsia; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Piperidines; Risk Factors

Trials on functional dyspepsia (FD) have been performed mostly in Western populations. We evaluated the effect of cisapride in Saudi Arabs with FD.. In a double-blind, randomized, placebo-controlled trial patients were treated with cisapride three times daily or matching placebo and assessed at 2 and 4 weeks.. Cisapride (n = 44) was significantly superior to placebo (n = 45) in improving heartburn, postprandial bloating, epigastric pain, early satiety, epigastric burning, and nausea. The global response to treatment was excellent or good in 86.7% and 26.7% of the cisapride and placebo groups, respectively. Treatment was judged more effective than the previous therapy in 86.4% and 33.3% of those receiving cisapride and placebo, respectively. There were no adverse drug effects.. Cisapride is an effective and well-tolerated treatment for FD in Saudi Arabs. Pharmacogenetic factors are unlikely to play any role in its effects.

Topics: Adult; Aged; Anti-Ulcer Agents; Cisapride; Double-Blind Method; Drug Administration Schedule; Dyspepsia; Female; Humans; Male; Middle Aged; Piperidines; Saudi Arabia; Treatment Outcome

To assess the efficacy of cisapride therapy in relieving symptoms of functional dyspepsia.. After a 2-week placebo run-in period, 61 out of 74 patients were eligible to enter a 4-week double-blind treatment phase, consisting of treatment with cisapride (10 mg) or placebo tablets t.d.s. Gastric emptying was assessed scintigraphically at entry to the study. Patients were stratified before treatment into those with or without active chronic (Helicobacter pylori) gastritis. Patients were also classified retrospectively into those with 'reflux-like' dyspepsia (n = 29) and those with 'motility-like' dyspepsia (n = 32).. At the end of the active treatment phase, there was a similar significant (P < 0.001) reduction in total symptom score from baseline in both cisapride (8.9 +/- 0.5 to 5.8 +/- 0.6) and placebo (9.7 +/- 0.6 to 5.5 +/- 0.6) groups. Scores for heartburn and continual bloating were significantly reduced in the cisapride but not the placebo group; improvement was attributable to patients with normal, rather than delayed, rates of gastric emptying. For continual bloating, significant improvement also occurred in the cisapride subgroup without gastritis, but not in the subgroup with gastritis (mean symptom score reduction 0.48 +/- 0.18, P = 0.03). For global evaluation by the investigator and by the patient, the overall improvement rates were not statistically different between cisapride and placebo groups. In those with normal gastric emptying, however, there was a significant (P = 0.01) improvement in general well-being in the cisapride but not in the placebo group.. We were unable to show major differences in the short-term efficacy of cisapride and placebo in functional dyspepsia. There were indications, however, of beneficial effects of cisapride over placebo in those with 'reflux-like' dyspepsia, and in those without gastroparesis.

Topics: Adult; Anti-Ulcer Agents; Cisapride; Double-Blind Method; Dyspepsia; Eructation; Female; Gastric Emptying; Heartburn; Humans; Male; Middle Aged; Nausea; Piperidines; Time Factors

To compare the efficacy of the prokinetic drug cisapride and the antisecretory agent ranitidine in relieving symptoms of functional dyspepsia, as well as their effect on the recurrence of symptoms after the discontinuation of treatment.. A randomized double-blind parallel-group trial of cisapride 30 mg daily and ranitidine 300 mg daily given for 2, 4 or 8 weeks, followed by a 4-week drug-free follow-up of the patients with a good or excellent response. Rescue antacid tablets were allowed only if pain was unbearable.. A total of 203 patients (99 cisapride, 104 ranitidine) with symptoms of functional dyspepsia for more than 4 weeks, after the exclusion of organic disease by endoscopy and sonography or radiology.. Cisapride and ranitidine improved the symptoms of diffuse epigastric pain, postprandial epigastric fullness, epigastric distension, belching, heartburn, regurgitation, and nausea when compared with baseline. Pain at night and gastric discomfort also greatly improved. Cisapride produced a greater reduction in epigastric pain (P = 0.07) and epigastric distension (P = 0.03) scores than ranitidine. Both drugs were equally effective in reducing the concomitant reflux-like symptoms of heartburn and regurgitation. At week 8, 87% of cisapride patients versus 61% of ranitidine patients had an excellent or good result. The deterioration of symptoms during the follow-up phase was limited in both groups. However, after the withdrawal of medication there was a greater reduction in scores in the cisapride group than in the ranitidine group for diffuse epigastric pain (P = 0.05), epigastric distension (P = 0.002), the cluster of six symptoms of epigastric discomfort (P = 0.05), and the cluster of all nine upper gastrointestinal symptoms (P = 0.06). Adverse events occurred in 15 cisapride patients and 18 ranitidine patients, and two of the ranitidine patients were withdrawn from treatment.. Although cisapride and ranitidine both improved the symptoms of functional dyspepsia, cisapride was superior to ranitidine, particularly on the combined evaluation of the response to treatment and the recurrence of symptoms.

Topics: Adult; Antacids; Anti-Ulcer Agents; Cisapride; Double-Blind Method; Dyspepsia; Eructation; Female; Follow-Up Studies; Gastroesophageal Reflux; Gastroscopy; Heartburn; Humans; Male; Nausea; Piperidines; Ranitidine; Recurrence

A controlled multi-centre clinical trial was conducted for evaluating the efficacy and safety of cisapride in the treatment of 414 cases of functional dyspepsia with 169 cases as control. Cisapride were given 5mg three times daily for 4 weeks. The results showed that cisapride could significantly improve the symptoms including early satiety, abdominal distention, epigastric pain and nausea. Total efficacy rate of cisapride and placebo were 92.99% and 41.42% respectively. There were statistically significant difference between the two groups. Side-effects are abdominal pain and diarrhoea but most of the patients can endure. The above results indicated that the cisapride was safe and effective in treatment of functional dyspepsia.

Topics: Abdominal Pain; Adolescent; Adult; Aged; Cisapride; Diarrhea; Dyspepsia; Female; Humans; Male; Middle Aged; Piperidines

Functional dyspepsia is a major diagnostic and therapeutic challenge for the clinician. Several systems for the identification of 'high-risk' patients and classifications of dyspepsia subtypes and treatment schemes have been proposed in the past with limited experimental evidence to support the claims made. The present trial was designed to compare two different treatment modalities in a group of functional dyspepsia patients selected on the basis of a standardized diagnostic procedure as 'non-risk' for organic disease and to assess the result in the major symptom sub-groups of functional dyspepsia as a means of identifying the potential for improving treatment outcome.. The efficacy of the prokinetic drug cisapride (5 mg four times daily) and of the histamine H2-receptor antagonist cimetidine (200 mg four times daily) were evaluated after 1 month of treatment and after a further follow-up of 1 month. Patients were randomized to the trial if they fulfilled the following criteria: 1) 'low-risk' symptoms or negative endoscopy findings, and 2) 2 weeks of single-blind antacid treatment did not provide satisfactory relief. For analysis patients were stratified into dyspepsia subtypes.. One hundred and sixty-one patients entered the run-in period, and 137 patients were randomized to the study. At the end of 4 weeks' treatment a small but significant difference in favour of cisapride was found; this difference can mainly be accounted for by the significant difference found in the dysmotility-like subtype (83% improved with cisapride versus 59% with cimetidine). No significant differences could be detected between drugs in the other dyspepsia subtypes at the end of the treatment-or follow-up period.. The study confirms the classification into dyspepsia-subtypes as a useful tool in selecting the most appropriate drug therapy.

Topics: Adult; Cimetidine; Cisapride; Double-Blind Method; Dyspepsia; Female; Humans; Male; Piperidines; Treatment Outcome

The efficacy and tolerability of cisapride (5 mg three times daily) and metoclopramide (10 mg three times daily) were evaluated in a randomized double-blind trial in patients with functional dyspepsia. Sixty patients, equally distributed in the two groups, entered the trial. After 4 weeks of treatment there was a significant improvement of symptom severity versus base line (p < 0.001) in both groups. The percentage of responders (with no or only mild symptoms) was 87% in the cisapride group and 77% in the metoclopramide group (no statistically significant intergroup difference). At the follow-up visit 2 weeks after completion of the trial this response rate was significantly higher in the cisapride group (73%) than in the metoclopramide group (47%) (p < 0.05). Four of the patients receiving cisapride and 2 of the patients receiving metoclopramide reported adverse events. On assessment of extrapyrimidal symptoms, relevant clinical values were found in one patient receiving metoclopramide. Increased prolactin concentrations were observed in seven patients of the metoclopramide group versus only 1 of the cisapride group (p < 0.05). The present data indicate that during the 2 weeks after completion of treatment in patients with functional dyspepsia, cisapride may result in a better, more sustained overall response when compared with metoclopramide.

Topics: Adult; Aged; Anti-Ulcer Agents; Cisapride; Double-Blind Method; Dyspepsia; Female; Humans; Male; Metoclopramide; Middle Aged; Piperidines; Prolactin

We conducted a double-blind study comparing two dosage regimens of a prokinetic drug, cisapride (10 mg q.d.s. and 20 mg b.d.), with a low dose of a H2-receptor antagonist (150 mg ranitidine b.d.) in the treatment of 155 patients with reflux oesophagitis as determined by endoscopy. The active treatment took 8 to 12 weeks depending on whether complete healing was found at endoscopy. Improvement in oesophagitis grades from baseline to endpoint was observed in 68% of patients in the 10 mg cisapride q.d.s. group, 83% in the cisapride 20 mg b.d. group and 81% in the ranitidine group (N.S.). At endpoint, the percentages of endoscopically cured patients with initial grades I or II were 52% for 10 mg cisapride q.d.s., 71% for 20 mg cisapride b.d. and 80% for ranitidine (N.S.). The proportional improvement of the overall reflux symptom score (60%) also showed no significant difference between the three groups. In the treatment of mild reflux oesophagitis (grades I and II) similar results can be expected from 20 mg cisapride b.d. and 150 mg ranitidine b.d. As the results of the two dosage regimens of cisapride were not different, the 20 mg twice daily regimen is preferred because it will improve patient compliance. It is concluded that in reflux oesophagitis grades I and II, the efficacy of 20 mg cisapride b.d. and 150 mg ranitidine b.d. are broadly similar.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aluminum Hydroxide; Antacids; Cisapride; Double-Blind Method; Drug Administration Schedule; Drug Combinations; Dyspepsia; Esophagitis, Peptic; Esophagoscopy; Humans; Magnesium Hydroxide; Middle Aged; Piperidines; Ranitidine; Serotonin Antagonists; Single-Blind Method

The efficacy and tolerability of Cisapride effervescent granules and a metoclopramide-dimethicone combination were compared double-blind in two comparable groups of 15 patients each with dyspepsia. All patients received three sachets daily of either drug for 6 consecutive weeks. As for efficacy, Cisapride effervescent granules was found to reduce 85% (11/13) of symptoms to a statistically significant extent, as against 42% (5/12) in the reference group. Statistical analysis showed Cisapride effervescent granules to be more effective than the reference drug for 6 out of 11 evaluable symptoms. Mean global improvement was 86% for Cisapride effervescent granules vs 41% for the reference combination. Final judgment by the physician was more favorable for Cisapride effervescent granules than for the reference drug (p < 0.0001). Treatment withdrawal was never necessary and no significant changes of laboratory values were observed. No statistically significant difference between the two treatments as to tolerability was observed. In conclusion, Cisapride effervescent granules was found to have a better risk/benefit ratio than the reference combination.

Topics: Adult; Aged; Aged, 80 and over; Capsules; Cisapride; Dose-Response Relationship, Drug; Double-Blind Method; Drug Evaluation; Dyspepsia; Female; Gastric Emptying; Gastrointestinal Transit; Humans; Male; Metoclopramide; Middle Aged; Piperidines; Risk Factors; Simethicone

Fifty-three patients with previously uninvestigated chronic dyspepsia symptoms in the absence of gastrointestinal or extra-gastrointestinal disease (functional dyspepsia) underwent antral and duodenal mucosal biopsies to detect the role of such samplings in the presence of normal endoscopic findings. Patients were enrolled in a randomized, placebo-controlled, double-blind trial, receiving either eradicating treatment (colloidal bismuth subcitrate plus metronidazole) or placebo if they had Helicobacter pylori-associated gastritis (20 patients), or cisapride or placebo if they had normal antral mucosa (28 cases). Unsuspected celiac sprue was found in one patient. Eradicating treatment ameliorated histological gastritis (p = 0.01). However, owing to great placebo efficacy, symptom remission rates following a 1-month wash-out period in both treatment groups were no higher than that in controls. Independent of the initial randomization, an extremely low symptom recurrence rate was observed during a drug-free follow-up study equivalent to the mean duration of symptoms before enrollment. We conclude that in functional dyspepsia, bulbar and antral biopsies are not useful in clinical management, equivalent symptom relief can be achieved in patients randomly assigned to both drugs and placebos, and such improvement can be long lasting in the absence of any maintenance treatment. We believe the prevalence of unsuspected villous atrophy and the therapeutic role of investigation-based reassurance deserve further assessment.

Topics: Adult; Anti-Bacterial Agents; Anti-Ulcer Agents; Biopsy; Bismuth; Cisapride; Double-Blind Method; Duodenum; Dyspepsia; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Organometallic Compounds; Piperidines; Pyloric Antrum

Twenty patients with functional dyspepsia were referred for radiologic examination and, upon confirmation of a hypomotile stomach, were given either 10 mg cisapride or placebo in a double-blind manner (10 patients per group). The movement of a 250-ml barium meal was assessed by means of television fluoroscopy performed at regular time intervals. Cisapride significantly improved antral contractility and enhanced gastric emptying compared with placebo. Deep peristaltic waves occurred over the entire small bowel, and motility and small-bowel transit time of the barium meal were significantly increased in the cisapride group compared with the placebo group. The study demonstrates that when a carefully defined protocol is observed, fluoroscopy following barium ingestion offers considerable potential in the assessment of gastrointestinal motility.

Topics: Barium Sulfate; Cisapride; Double-Blind Method; Dyspepsia; Fluoroscopy; Gastric Emptying; Gastrointestinal Motility; Gastrointestinal Transit; Humans; Piperidines; Pyloric Antrum

The efficacy and tolerability of cisapride in chronic dyspepsia was evaluated in a randomized, double-blind, placebo-controlled study. After 4 weeks' treatment with oral cisapride 10 mg three times daily (n = 14), bloating and epigastric discomfort were significantly reduced compared with placebo (n = 15; p < 0.05). Moreover, the global response to treatment was excellent or good in 71.4% of patients in the cisapride group versus 20.0% with placebo. No significant side effects were observed. It is concluded that cisapride is an effective and well-tolerated treatment for chronic dyspepsia.

Topics: Adolescent; Adult; Chronic Disease; Cisapride; Double-Blind Method; Dyspepsia; Female; Gastrointestinal Motility; Humans; Male; Piperidines; Severity of Illness Index; Treatment Outcome

In a Dutch general practice trial conducted in 599 patients with symptoms of dyspepsia, the response to 5 mg cisapride three times daily was rated excellent or good in 61% of patients at week 2. On increasing the dose to 10 mg three times daily in 132 patients with poor to moderate response, the result at the end of treatment was rated as good or excellent in 45% of these patients, and the mean symptom score further decreased significantly (p < 0.05). The longer the pretreatment duration of dyspeptic symptoms, the lower was the overall response rate to cisapride short-term therapy (80% in patients with complaints < 3 months versus 50% in those with complaints > 4 years). Cisapride also proved effective in patients previously treated with prokinetic agents (72% response rate), antacids (66%) and H2-receptor antagonists (48%). On long-term follow-up, dyspepsia relapse rates among the total patient population (n = 357) and the patient sample fully 'cured' after 4 weeks of cisapride (n = 226) were respectively 30% and 27% after 6 months. Factors affecting recurrence of dyspeptic symptoms included age, duration of symptoms prior to trial entry and mean symptom score at end of the treatment study, but not the symptom severity prior to treatment. Relapsing patients presented mainly with the same symptom profile as at the first study, and the majority (88%) responded well to repeated treatment with cisapride. In conclusion, most patients responded well to a short therapeutic trial with cisapride and remained free from relapse in the subsequent 6 months. Repeated treatment in patients with recurrent symptoms appeared to be successful.

Topics: Adult; Age Factors; Aged; Cisapride; Dyspepsia; Female; Follow-Up Studies; Gastrointestinal Motility; Humans; Male; Middle Aged; Piperidines; Recurrence; Severity of Illness Index; Time Factors; Treatment Outcome

A double-blind, placebo-controlled trial was performed to determine the therapeutic efficacy of cisapride in patients with refractory functional dyspepsia. A total of 147 patients with functional dyspepsia characterized by prominent epigastric pain or discomfort were randomized to 2 weeks' treatment with metoclopramide or domperidone (both 30 mg/day); of these, 53 patients unresponsive to dopamine antagonist treatment were randomized to cisapride 30 mg/day or placebo for an additional 2 weeks. Metoclopramide and domperidone produced comparable alleviation of epigastric symptoms; global efficacy was good or excellent in 62% and 57% of patients, respectively. In refractory patients, cisapride tended to display greater efficacy than placebo against epigastric pain, particularly at night. Global assessments of efficacy significantly favored cisapride over placebo, with good or excellent ratings in 65% and 32% of patients, respectively. Cisapride was well tolerated. Thus, cisapride appears to be an effective agent in functional dyspepsia unresponsive to other gastrokinetic agents.

Topics: Adolescent; Adult; Aged; Chronic Disease; Cisapride; Domperidone; Double-Blind Method; Dyspepsia; Female; Gastrointestinal Motility; Humans; Male; Metoclopramide; Middle Aged; Piperidines; Treatment Outcome

This trial included patients from general practice with endoscopy-negative chronic dyspepsia and epigastric pain or discomfort. Eleven eligible patients with sufficiently severe dyspeptic symptoms after a 2-week placebo run-in period were entered into a 4-week, parallel group, double-blind randomized comparison of 10 mg cisapride three times daily and matched placebo, and were subsequently evaluable. Symptoms were comparable in the two treatment groups at the start of double-blind treatment. The cisapride group had a significantly greater reduction in the frequency of daytime epigastric pain/discomfort and the frequency and severity of nocturnal pain/discomfort after 2 weeks. After 2 weeks, all six cisapride recipients were free of nocturnal pain, compared with only one of five placebo recipients. After 4 weeks of double-blind therapy, improvements in the placebo group had reduced between-treatment differences, with five of six cisapride recipients and three of five placebo recipients being free of nocturnal pain. Cisapride was well tolerated.

Topics: Abdominal Pain; Adult; Aged; Chronic Disease; Cisapride; Double-Blind Method; Dyspepsia; Family Practice; Female; Gastrointestinal Motility; Humans; Male; Middle Aged; Piperidines

One hundred and twenty consecutive outpatients with non-ulcer dyspepsia (NUD) and erosive prepyloric changes (EPC) were, after a 2-week placebo run-in period, randomly allocated to double-blind treatment with either 10-mg cisapride tablets or placebo three times daily for 4 weeks. The patients' global evaluation and total symptom score were significantly in favour of cisapride at 2 weeks (p less than 0.05). At 4 weeks the effect of cisapride was no longer significant (p = 0.22). Similarly, the investigators' global evaluation showed marked to moderate symptom improvement in 47% of the cisapride-treated patients as compared with 30% of the placebo-treated patients at 2 weeks. The 95% confidence interval of the difference (18%) was 0% to 35%. At 4 weeks the intergroup difference was only 10% (cisapride, 50% versus placebo 40%). Pain on awakening was the only symptom improved in favour of cisapride at 4 weeks. Thus, when patients with NUD and EPC are treated with cisapride, the therapeutic gain might vanish after the 2nd week of treatment.

Topics: Adult; Cisapride; Confidence Intervals; Double-Blind Method; Dyspepsia; Female; Gastric Mucosa; Humans; Male; Middle Aged; Piperidines; Serotonin Antagonists

Fasting antral area was examined by ultrasonography in 40 healthy subjects and in 106 patients with non-ulcer dyspepsia (NUD) and erosive prepyloric changes (EPC) before and after treatment with cisapride or placebo. The patients were examined twice, first after a run-in period of 14 days of placebo and then after 14 days of cisapride, 10 mg three times daily, or placebo. The relaxed width of the antral area was measured in two sections: a vertical section in which the antrum, the superior mesenteric vein, and the aorta were visualized simultaneously, and a horizontal section that included the pylorus and the middle of the antrum up to 5 cm proximal to the pylorus. The mean antral area was wider (p less than 0.001), both in vertical and horizontal sections, in patients with NUD and EPC than in controls. The antral area in NUD patients was wider (p less than 0.05) in smokers than in non-smokers. The area tended to decrease during treatment with cisapride (p = 0.08). Bloating was the only symptom significantly associated with a wide antral area (p = 0.01). The results suggest a relationship between a wide fasting antral area and NUD with EPC.

Topics: Adolescent; Adult; Aged; Cisapride; Double-Blind Method; Dyspepsia; Fasting; Female; Gastrointestinal Motility; Humans; Male; Middle Aged; Piperidines; Pyloric Antrum; Serotonin Antagonists; Smoking; Ultrasonography

The effects on gastric emptying and gastrointestinal symptoms of treatment with cisapride alone and in combination with domperidone were investigated in 25 patients with chronic idiopathic dyspepsia. In a double-blind study, 9 patients were randomly assigned to receive cisapride 2.5 mg three times daily, and 8 patients to receive placebo. After 7 days of treatment, gastric emptying was significantly accelerated and the score of gastrointestinal symptoms was significantly reduced in patients treated with cisapride. Placebo treatment had no significant effect. A randomized, double-blind crossover study of 8 patients compared the effects of combined treatment with cisapride 2.5 mg plus domperidone 10 mg three times daily for 7 days against the effects of cisapride plus placebo. Administration of cisapride plus domperidone gave significantly higher gastric emptying and lower gastrointestinal symptoms than cisapride plus placebo.

Topics: Chronic Disease; Cisapride; Domperidone; Double-Blind Method; Drug Therapy, Combination; Dyspepsia; Female; Gastric Emptying; Humans; Male; Middle Aged; Piperidines; Serotonin Antagonists

Gastric and gallbladder emptying after a standard liquid meal were studied in 65 patients with early satiety, bloating, pain at the right hypochondrium or the epigastrium, nausea, and occasionally vomiting. Fifty normal subjects were studied as a control group. Gastric and gallbladder emptying were evaluated by means of real-time ultrasonography (RUS). Serial RUS scans were made after a 12-hr fast and every 15 min after a standard meal for 2 hr. Patients were considered to have delayed gastric emptying or hypokinetic gallbladder when gastric diameters and gallbladder volume evaluated 45 min after meal were 2 SD above the corresponding mean values of the normal subject group. Fifteen patients (23%) were found with delayed gastric emptying and 20 (30.7%) a reduced gallbladder emptying. None of our patients showed delayed gastric emptying and hypokinetic gallbladder simultaneously. The 20 patients with reduced gallbladder emptying were included in a double-blind randomized, placebo controlled, change-over study with cisapride (10 mg three times a day) for 30 days. Cisapride treatment reversed the gallbladder hypomotility within the normal range while placebo did not change the response to meal. Symptom score improved significantly after cisapride and placebo. It is concluded that in dyspeptic patients with reduced gallbladder response to a meal cisapride may be of help in improving the kinetic abnormality. Dyspeptic symptoms, however, do not seem to be corrected with the described gallbladder motor abnormality.

Topics: Adult; Cisapride; Double-Blind Method; Dyspepsia; Female; Gallbladder Diseases; Gallbladder Emptying; Gastric Emptying; Humans; Male; Middle Aged; Piperidines

The clinical efficacy and the safety of chronic oral administration of cisapride, a new gastrointestinal prokinetic agent, (10 mg tid) and clebopride (0.5 mg tid) was assayed in 48 outpatients affected with functional dyspepsia, in a randomized double-blind study. Each of the drugs induced a significant reduction in dyspeptic symptoms after 2 and 4 weeks (p less than 0.001). Two patients, given clebopride, dropped out of the study because of severe side effects during the first week of treatment. Mild adverse reactions were reported in 6 out of 23 cisapride-treated patients and in 10 out of 20 clebopride-treated patients who completed the study. The most common side effect of cisapride was diarrhoea and that of clebopride was drowsiness. Cisapride appears to be as effective as clebopride in reducing dyspeptic symptoms and seems to induce less severe side effects.

Topics: Administration, Oral; Adolescent; Adult; Aged; Antiemetics; Benzamides; Chronic Disease; Cisapride; Double-Blind Method; Dyspepsia; Female; Humans; Male; Middle Aged; Piperidines; Serotonin Antagonists

Controlled studies showed that cisapride is effective in non-ulcer dyspepsia. Its prokinetic properties are not complicated by dopamine inhibition. In our study the dose of 5 mg t.i.d. was adequate for the treatment of patients with gastric symptoms, while for patients with reflux symptoms the preferred dose is 10 mg t.i.d. cisapride. The average improvement after 1 month of treatment was 68%. Additional medication with antacids was not of benefit. Side effects such as abdominal cramps or diarrhea were minimal (less than 4%). 1071 patients were selected according to the principles described by Talley et al. in 1987. This method was well accepted by investigators and patients and is recommended for similar studies.

Topics: Antacids; Cisapride; Dose-Response Relationship, Drug; Dyspepsia; Female; Gastroesophageal Reflux; Humans; Male; Middle Aged; Piperidines; Serotonin Antagonists

A retrospective study is reported carried out on a group of 166 patients affected by dyspeptic syndrome who presented at least 3 of the 9 symptoms which characterise this pathology. One hundred and twenty-eight patients underwent prokinetic drug therapy and 38 received placebo. Clinical parameters were evaluated following one month of therapy all patients in order to compare them to basal values. The results obtained confirm a satisfactory efficacy of the prokinetic treatment in improving dyspeptic symptoms. Although administered to a smaller number of patients, placebo was also found to play an important role in the multifactorial etiopathogenesis of the dyspeptic syndrome on a functional basis.

Topics: Adult; Antiemetics; Benzamides; Cisapride; Domperidone; Dyspepsia; Female; Humans; Male; Metoclopramide; Middle Aged; Piperidines; Retrospective Studies; Serotonin Antagonists

Topics: Cisapride; Clinical Trials as Topic; Constipation; Dyspepsia; Gastroesophageal Reflux; Gastrointestinal Diseases; Gastrointestinal Motility; Humans; Intestinal Pseudo-Obstruction; Piperidines; Serotonin Antagonists; Stomach Ulcer

Topics: Cisapride; Dose-Response Relationship, Drug; Double-Blind Method; Dyspepsia; Humans; Multicenter Studies as Topic; Piperidines; Randomized Controlled Trials as Topic; Serotonin Antagonists

Topics: Cisapride; Dose-Response Relationship, Drug; Dyspepsia; Humans; Multicenter Studies as Topic; Piperidines; Randomized Controlled Trials as Topic; Serotonin Antagonists

We have evaluated the effect of cisapride on interdigestive antroduodenal motility during a prolonged oral therapy in 20 consecutive dyspeptic subjects. Individuals with less than two migrating motor complexes (MMCs) starting from the antral region in 240 minutes and without evidence of upper gastrointestinal tract diseases were randomly treated with either cisapride (10 cases), or placebo (10 cases) for 15 days. Computerised manometry of antroduodenal region was performed for 240 minutes, in basal conditions and on the 15th day of therapy. Symptomatic evaluation of patients was also performed before and after treatment. After cisapride administration, a significant increase in the incidence of antral migrating motor complexes was noticed (p = 0.022); likewise, the motility index, calculated for phase-2 periods, appeared to be significantly higher both in the antrum and in the duodenum (p less than 0.001). Symptomatic improvement was observed in both groups, with a hardly significant (p = 0.049) reduction of dyspeptic symptoms severity only but not of frequency in cisapride treated patients v controls. We conclude that longterm oral therapy with cisapride improves interdigestive antroduodenal motor activity.

Topics: Administration, Oral; Adult; Cisapride; Digestion; Duodenum; Dyspepsia; Female; Gastrointestinal Motility; Humans; Male; Middle Aged; Piperidines; Pyloric Antrum; Serotonin Antagonists; Time Factors

Gastric emptying was studied in 10 insulin-treated, long-standing, diabetic out-patients with upper gastrointestinal, dyspeptic symptoms. Autonomic neuropathy, mucosal lesions and chloropeptic hyposecretion were excluded. Gastric emptying of a labelled solid meal (99mTc-sulphur colloid-infiltrated chicken liver) was clearly delayed by comparison with normal subjects: the mean gastric emptying half-time was almost 5-times longer (245.6 vs 52.5 min), and the gastric emptying rate at 120 min was 75% slower. Cisapride 10 mg i.v. significantly accelerated both parameters, and placebo had no effect upon them. In conclusion, gastroparesis may be present in diabetics without autonomic neuropathy, and cisapride may improve gastric emptying in such patients.

Topics: Adult; Cisapride; Diabetes Mellitus, Type 1; Dyspepsia; Female; Gastric Emptying; Humans; Male; Middle Aged; Piperidines; Serotonin Antagonists

Twenty-eight patients with chronic idiopathic dyspepsia defined by the presence of chronic unexplained symptoms suggestive of gastric stasis and directly related to food ingestion were included in this prospective study. Gastric emptying of the liquid and solid phases of a meal was quantified by a dual-isotope method, and symptoms were evaluated by a diary and a visual analog scale. Delay in gastric emptying was evidenced in 59% of the dyspeptic patients; it occurred with liquids in more cases than solids. Quantitative and qualitative evaluation of symptoms was of no practical value in predicting the presence of objective stasis. The dyspeptic patients were included in a double-blind randomized controlled trial of cisapride, a new gastrokinetic drug devoid of central antiemetic effects. After six weeks of cisapride treatment, all patients with initially abnormal gastric emptying rates for liquids, and all but one for solids returned to normal ranges, and significant differences between cisapride and placebo groups were observed for half emptying times of both solids (136 +/- 16 min vs 227 +/- 32 min; P less than 0.02) and liquids (61 +/- 4 min vs 132 +/- 37 min; P less than 0.01). Cisapride also significantly improved dyspeptic symptom scores at weeks 3 and 6 of treatment as compared to those measured before treatment. Nevertheless, the decrease in global diary score was significantly higher than that seen with placebo at week 3 (-16 +/- 6 vs -1 +/- 9; P less than 0.05), but not at week 6 (-18 +/- 5 vs -10 +/- 8).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Chronic Disease; Cisapride; Clinical Trials as Topic; Double-Blind Method; Dyspepsia; Female; Gastric Emptying; Humans; Male; Middle Aged; Patient Compliance; Piperidines; Placebos; Radionuclide Imaging; Random Allocation; Serotonin Antagonists; Time Factors

In a randomized, double-blind, placebo-controlled study, 32 patients with nonulcer dyspepsia received 5 mg of cisapride or placebo three times daily for four weeks after a two-week run-in phase on placebo. Limited antacid use was allowed. Cisapride was superior to placebo in reducing the intensity of epigastric pain at two weeks (P = 0.03) and four weeks (P = 0.01). At the end of treatment, 82% of the cisapride-treated patients and 43% of the controls had no or only mild pain. Minor, gastrointestinal side effects were observed in two cisapride-treated patients and in one control.

Topics: Adult; Antacids; Cisapride; Clinical Trials as Topic; Double-Blind Method; Dyspepsia; Female; Humans; Male; Pain; Piperidines; Random Allocation; Serotonin Antagonists; Time Factors

Non-ulcer dyspepsia is gaining increasing interest among gastroenterologists even though the pathogenetic mechanisms in individual patients are still unknown. On the basis of a number of studies, it can be concluded that in about 60% of patients impairment of gastric evacuation may contribute to the symptomatology (epigastric pain, postprandial fullness, early satiety, bloating, nausea and vomiting). This review summarizes the results of 10 placebo-controlled trials which evaluated the effects of cisapride (3 x 5 or 3 x 10 mg/day) in strict non-ulcer dyspepsia or functional postprandial dyspepsia. In seven of the trials, cisapride proved significantly superior to placebo in relieving epigastric pain and concomitant symptoms in patients with non-ulcer dyspepsia. In the three studies examining chronic functional dyspepsia, belching, postprandial bloating, early satiety and heartburn were significantly improved. In all 10 trials, cisapride was significantly superior to placebo.

Topics: Cisapride; Clinical Trials as Topic; Double-Blind Method; Dyspepsia; Humans; Piperidines; Serotonin Antagonists

Duodenogastric reflux has a deleterious effect on the gastric mucosa. It was the aim of this study to assess the acute effects of cisapride on antroduodenal motility and duodenogastric reflux in seven patients with severe dyspepsia and increased biliary reflux, as evidenced by increased bile salt output in their gastric aspirates. Each patient underwent two studies on separate days. On each day, after an overnight fast, each patient swallowed a multilumen tube for manometric recording of gastroduodenal motility. Phenol red was infused into the second portion of the duodenum, gastric juice was aspirated, and motor activity was monitored for 90 min. At the end of this period, the patient received either cisapride or placebo intravenously in a double-blind randomized fashion. Antroduodenal motility and duodenogastric reflux were monitored for the subsequent 90 min. A significantly (P less than 0.01) higher motility index was found in the antrum after cisapride (2678 +/- 712 vs 1110 +/- 412 in the basal period) while placebo had no effect. The duodenal motility index was not affected by cisapride or placebo. Bile salt outputs in gastric aspirates were significantly (P less than 0.05) reduced following cisapride injection (0.42 +/- 0.6 mmol vs 1.6 +/- 1.2 mmol during basal period). Conversely, outputs of phenol red in the gastric aspirates were unaffected by cisapride. In conclusion, cisapride stimulates antral motility and decreases biliary reflux in patients with dyspepsia and increased duodenogastric reflux.

Topics: Adult; Aged; Bile Acids and Salts; Cisapride; Double-Blind Method; Duodenogastric Reflux; Dyspepsia; Female; Gastric Juice; Gastrointestinal Motility; Humans; Male; Middle Aged; Phenolsulfonphthalein; Piperidines; Prospective Studies

The effects of cisapride, a nondopaminolytic motility-enhancing agent, were studied in 56 patients with chronic functional dyspepsia; all had symptoms suggestive of delayed gastric emptying. The patients received 4 mg or 8 mg of cisapride or placebo orally three times daily for two successive three-week periods according to a randomized, double-blind, crossover study design. Although there was a high placebo response (55% showed good or excellent results), the global response to treatment was significantly (P = 0.024) in favor of cisapride (75% had good or excellent results). The drug was particularly superior to placebo (P = 0.03) in the improvement of a cluster of symptoms typical of postprandial discomfort, including early satiety and nausea. Side effects were minimal.

Topics: Adolescent; Adult; Aged; Chronic Disease; Cisapride; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Dyspepsia; Female; Gastric Emptying; Humans; Male; Middle Aged; Piperidines; Random Allocation

In a double blind crossover comparison with placebo, the effects of cisapride (10 mg tid for two weeks), a non-antidopaminergic gastrointestinal prokinetic drug, on gastric emptying times and on symptoms were evaluated in 12 patients with chronic idiopathic dyspepsia and gastroparesis. Gastric emptying was studied by a radioisotopic gamma camera technique. The test meal was labelled in the solid component (99mTc-sulphur colloid infiltrated chicken liver). Nine symptoms (nausea, belching, regurgitations, vomiting, postprandial drowsiness, early satiety, epigastric pain or burning, heartburn) were graded weekly on a questionnaire. Cisapride was significantly more effective than placebo in shortening the t1/2 of gastric emptying (p2 = 0.04), but no significant difference was observed between the two treatments with regard to the improvement of total symptom score (p2 = 0.09). No side effects were reported during the study.

Topics: Adult; Cisapride; Clinical Trials as Topic; Double-Blind Method; Dyspepsia; Female; Gastric Emptying; Humans; Male; Middle Aged; Paralysis; Piperidines; Stomach Diseases

The effect of cisapride, 10 mg three times daily, was evaluated in a double-blind randomized study in 118 patients with non-ulcer dyspepsia. Peptic ulcer disease was excluded by endoscopy, gallstones by ultrasonography, and chronic pancreatitis by a series of non-invasive tests. Symptomatic improvement was evaluated by interview after 2 and 4 weeks; the patients also kept a diary. Cisapride caused significant improvement compared with placebo with regard to frequency and severity of symptoms and may therefore be useful in the therapy of non-ulcer dyspepsia.

Topics: Cisapride; Clinical Trials as Topic; Double-Blind Method; Dyspepsia; Humans; Peptic Ulcer; Piperidines; Random Allocation

Topics: Cisapride; Clinical Trials as Topic; Double-Blind Method; Dyspepsia; Gastric Emptying; Humans; Piperidines

Symptoms suggesting gastroparesis in patients without gastric outlet obstruction are very common but their relation to an objective delay of gastric emptying has been poorly investigated. A dual isotopic technique was used to evaluate patients with non-obstructive dyspepsia (idiopathic and secondary) (part 1) and to assess the effects of a new gastrokinetic agent: cisapride, on gastric emptying in such patients (part 2). Sixty patients with postprandial dyspeptic symptoms (vomiting, nausea, gastric bloating or full feeling) and without lesions at upper endoscopy were studied. They were distributed into three groups: idiopathic dyspepsia (n = 31), postvagotomy dyspepsia (n = 16) and dyspepsia secondary to medical disorders (n = 13). All patients ingested the same ordinary meal; 99mTc sulphur colloid tagged egg white was the solid phase marker and 111In chloride was the liquid phase marker. In part 1, evaluation of gastric emptying in the first 50 patients shows a delay of gastric emptying rate of solids and liquids as compared with controls. Striking differences separate the three groups of patients, however, percentages of delayed gastric emptying rate of solids and or liquids averaged 90% in postvagotomy or secondary dyspepsia groups whereas it was 44% in idiopathic dyspepsia group. Moreover, liquid emptying rate was often the only one impaired in idiopathic dyspepsia, and in 12 of the 27 patients of this group the faster emptying rate of liquids as compared with that of solids (always found in normal subjects), could not be evidenced. In part 2, 10 patients entered a double blind cross over study of cisapride (8 mg intravenously). A significant increase of solid (p<0.01) and liquid (p<0.05) emptying rates was found in patients with initial gastric emptying delay. This study emphasises the importance of an objective evaluation of gastric emptying in the presence of symptoms of gastric stasis and suggests that specific local acting therapy may be useful in patients with identified abnormal gastric emptying.

Topics: Adult; Aged; Cisapride; Clinical Trials as Topic; Double-Blind Method; Drug Evaluation; Dyspepsia; Female; Gastric Emptying; Humans; Indium; Male; Middle Aged; Piperidines; Technetium Tc 99m Sulfur Colloid; Time Factors; Vagotomy

The anti-emetic effects of domperidone were evaluated under double-blind conditions in twenty-four patients with acute vomiting randomly assigned to treatment either with 10 mg i.m. domperidone (six female, five males) or with placebo (seven females, six males). The therapeutic results were better with domperidone and the differences from placebo were statistically significant (p less than 0.02). In a second randomized, crossover, double-blind trial, domperidone (10 mg t.i.d.) evaluated according to a nine-symptom rating scale, in eighteen dyspeptic patients, proved significantly more effective than placebo. The duration of treatment was 6 weeks and the drugs were crossed-over after 3 weeks. The difference between the two groups was most marked during the second phase of the trial. No side-effects were reported.

Topics: Aged; Benzimidazoles; Clinical Trials as Topic; Domperidone; Double-Blind Method; Dyspepsia; Female; Humans; Male; Middle Aged; Piperidines; Vomiting

Topics: Adult; Benzimidazoles; Domperidone; Double-Blind Method; Drug Evaluation; Dyspepsia; Female; Humans; Male; Metoclopramide; Middle Aged; Piperidines; Placebos

Topics: Adult; Aged; Benzimidazoles; Clinical Trials as Topic; Dopamine Antagonists; Dyspepsia; Eructation; Female; Gastrointestinal Motility; Humans; Male; Middle Aged; Piperidines

Oral domperidone (30 mg/day) or placebo tablets were given to 41 patients presenting with symptoms of chronic post-prandial dyspepsia, in a double blind study. The tablets were taken three times a day before meals. The first part of the study lasted four weeks and was followed by a second four week period in which domperidone was given on an open basis to all subjects. At the end of the double-blind phase all indices but one (bitter regurgitation) as well as the gastro-oesophageal reflux cluster had significantly improved on domperidone treatment while none had done so on placebo. During the subsequent open four weeks of domperidone all items improved in both study groups. No side effects were seen in any of the participants in the study.

Topics: Adult; Aged; Antiemetics; Benzimidazoles; Chronic Disease; Clinical Trials as Topic; Double-Blind Method; Dyspepsia; Female; Food; Humans; Male; Middle Aged; Piperidines; Placebos

A doubld-blind crossover study of oral domperidone (10 mg t.d.s.) involving 48 patients suffering from chronic postprandial dyspepsia, showed a significant relief of symptoms on active treatment compared to placebo. The trial lasted eight weeks, the crossover in medication taking place at four weeks. Side effects were rare and mild and it is concluded that domperidone could be a very useful drug for the symptomatic treatment of upper gastrointestinal distress.

Topics: Adolescent; Adult; Antiemetics; Benzimidazoles; Chronic Disease; Clinical Trials as Topic; Double-Blind Method; Dyspepsia; Female; Food; Humans; Male; Middle Aged; Piperidines

Forty patients who were suffering from chronic dyspepsia, diagnosed clinically and radiologically as being related to delayed gastric emptying, were treated with either domperidone or placebo in a double-blind trial. The trial lasted four weeks and the dose of domperidone was 10 mg orally t.d.s. before meals. The results showed that the drug markedly improved symptoms and that side effects were few, being recorded in one patient only, on active treatment. It is concluded that domperidone is a useful agent for the treatment of dyspepsia with retarded gastric emptying.

Topics: Adult; Aged; Antiemetics; Benzimidazoles; Chronic Disease; Clinical Trials as Topic; Double-Blind Method; Dyspepsia; Female; Gastric Emptying; Humans; Male; Middle Aged; Piperidines; Placebos

Forty patients with postprandial nausea and vomiting from a variety of underlying causes, were given either domperidone 20 mg t.d.s. or placebo in a double-blind study lasting two weeks. The tablets were taken before meals and no other anti-emetics were used. Nausea and vomiting were reduced in those patients given the active therapy, the results being recorded as excellent in 62% in the domperidone group and 18% of controls.

Topics: Adult; Aged; Antiemetics; Benzimidazoles; Chronic Disease; Clinical Trials as Topic; Double-Blind Method; Dyspepsia; Female; Food; Humans; Male; Middle Aged; Nausea; Piperidines; Vomiting

Domperidone, at a dosage of 20 mg t.d.s before meals, in a double-blind, crossover, placebo-controlled trial reduced the level of the symptoms of dyspepsia by 76% compared to a 16% reduction with placebo. This difference was statistically significant (p less than 0.001). Thirteen of the fourteen patients in the study preferred domperidone to placebo. Four patients in the active treatment period and one in the placebo complained of mild side-effects.

Topics: Adult; Aged; Benzimidazoles; Chronic Disease; Double-Blind Method; Drug Evaluation; Dyspepsia; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Piperidines; Placebos

32 patients with chronic postprandial dyspepsia were selected for a 4-week controlled double-blind trial of domperidone and a placebo. The patients received either domperidone or a placebo at a dose rate of two 10-mg tablets t.i.d. before meals. A questionnaire was completed at the start of the study, and after 2 and 4 weeks of treatment. Excellent or good improvement was obtained in 71% of the domperidone-treated patients compared to only 13% of the placebo-treated cases. Domperidone was also significantly superior to the placebo when both drugs were compared to previously used medications. Side effects were not reported. It is concluded that domperidone has a beneficial effect on chronic postprandial dyspepsia.

Topics: Adult; Aged; Antiemetics; Benzimidazoles; Chronic Disease; Double-Blind Method; Drug Evaluation; Dyspepsia; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Piperidines; Placebos

It is still controversial which drugs, proton pump inhibitors (PPI) or histamine-2 receptor antagonists (H2RA), are more effective for dyspepsia in the Japanese population.. Patients with uninvestigated dyspepsia (n = 104; male/female 41/63) were treated with either rabeprazole 10 mg o.d. (n = 62) or lafutidine 10 mg b.i.d. (n = 42) for 4 weeks. Questionnaires (modified Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease [mFSSG] and quality of life [QOL], SF-8) were administered before and after therapy. The mFSSG was classified into a total score (Q-T), reflux score (Q-R), dyspepsia score (Q-D) and pain score (Q-P). The SF-8 had a physical component summary (PCS) and mental component summary (MCS). The predominant type of symptom was reflux (R-S), pain (P-S) or dysmotility (D-S).. R-S was 19.2%, P-S 48.1%, D-S 24.0% and overlap 8.7%. In the R-S, Q-T and Q-R significantly improved with rabeprazole, but neither scale improved with lafutidine. MCS significantly improved with rabeprazole. In P-S, Q-T, Q-R, Q-D and Q-P significantly improved with both drugs. PCS significantly improved with both, whereas the MCS significant improved with rabeprazole. In D-S, Q-R and Q-D significant improved with rabeprazole, but neither improved with lafutidine. QOL did not improve with either. With overlap, neither scale nor the QOL reached a significant difference.. Both PPI and H2RA have a positive effect on P-S, but H(2)RA therapy is limited for R-S and D-S, whereas PPI therapy is generally effective. Therefore, careful prescription based on symptoms is important.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Acetamides; Adult; Dyspepsia; Esophageal Motility Disorders; Female; Gastroesophageal Reflux; Histamine H2 Antagonists; Humans; Japan; Male; Middle Aged; Pain; Pain Measurement; Piperidines; Proton Pump Inhibitors; Pyridines; Rabeprazole; Retrospective Studies; Severity of Illness Index; Surveys and Questionnaires; Treatment Outcome

Therapy for the relief of symptoms of functional dyspepsia is unpredictable.. To identify which patients may benefit from antisecretory therapy.. Twenty-seven patients with functional dyspepsia were selected to receive H2-receptor antagonist (H2RA) treatment for 4 weeks. Serum pepsinogen A, pepsinogen C and gastrin were measured, and Helicobacter pylori status was determined. Symptoms were assessed at baseline and after H2RA treatment.. Fourteen patients were identified as H2RA responders and the remaining patients were non-responders. No differences were found between responders and non-responders with regard to serum pepsinogen A, pepsinogen C, gastrin and H. pylori status. However, the pepsinogen A/C ratio was significantly higher in responders than in non-responders. Ten of the 13 functional dyspepsia patients (77%) with a high value of the pepsinogen A/C ratio (> or = 4.5) achieved symptom resolution by H2RA, compared with only one of the eight patients (13%) with a low value of the pepsinogen A/C ratio (< or = 3.0).. The serum pepsinogen A/C ratio seems to identify those functional dyspepsia patients for whom acid control provides benefit. This ratio may be a practical tool for the management of functional dyspepsia patients.

Topics: Adult; Aged; Anti-Ulcer Agents; Biomarkers; Dyspepsia; Female; Gastrins; Helicobacter pylori; Histamine H2 Antagonists; Humans; Male; Middle Aged; Patient Selection; Pepsinogen A; Pepsinogen C; Piperidines; Treatment Outcome

Topics: Cisapride; Double-Blind Method; Dyspepsia; Family Practice; Gastrointestinal Agents; Histamine H2 Antagonists; Humans; Nizatidine; Piperidines; Randomized Controlled Trials as Topic; Reproducibility of Results

Topics: Anti-Ulcer Agents; Cisapride; Double-Blind Method; Dyspepsia; Humans; Piperidines; Placebo Effect; Randomized Controlled Trials as Topic

Patients receiving interferon-alpha often experience symptoms such as upper abdominal discomfort, anorexia, and nausea, which suggest a delay in gastric emptying. Reduction of the dosages of interferon-alpha or even interruption of the treatment is sometimes required because of these symptoms. The present study was designed to investigate the effect of interferon-alpha on gastric emptying and to evaluate the effects of cisapride on gastric emptying and upper abdominal symptoms during interferon-alpha therapy.. Gastric emptying in 14 patients with chronic hepatitis C was estimated by the sulfamethizole capsule method before and 1 and 2 weeks after the beginning of interferon-alpha (6 million U/day) therapy.. Before therapy none of the patients complained of upper abdominal symptoms, and all had normal gastric emptying. Interferon treatment delayed gastric emptying in 12 of the patients and induced discomfort and anorexia in 9 of the patients. The administration of cisapride reversed the delayed gastric emptying in six of seven patients and relieved abdominal discomfort and anorexia.. These findings indicate that interferon-alpha delays gastric emptying and suggest that cisapride administration corrects the delayed gastric emptying and relieves the abdominal symptoms associated with interferon-alpha therapy.

Topics: Antiviral Agents; Cisapride; Dyspepsia; Female; Gastric Emptying; Gastrointestinal Agents; Hepatitis C; Hepatitis, Chronic; Humans; Interferon Type I; Male; Middle Aged; Piperidines; Recombinant Proteins; Sulfamethizole

Prokinetic therapy has been shown to improve patients' symptoms associated with gastrointestinal motility disorders and quality of life. This study investigated the correlation between clinical improvement and quality of life after 12 months of treatment with cisapride or domperidone in patients with severe dyspepsia. Psychological and quality-of-life measures were assessed at baseline and after 12 months of therapy using three patient-administered, standardized questionnaires: the Minnesota Multiphasic Personality Inventory, the Millon Behavioral Health Inventory, and the Sickness Impact Profile. Changes in clinical symptoms were correlated with changes in these measures. Twenty-seven patients with symptoms of severe dyspepsia were treated with cisapride or domperidone (60-80 mg/day) for 12 months. Symptoms and quality-of-life measures were improved at the end of therapy. There were significant correlations between improvement in clinical symptoms and improvement in quality of life parameters. Patients with more marked symptom improvement had more significant improvements in quality of life measures. We conclude that prokinetic therapy improved symptoms and quality of life. Standardized questionnaires can be used to quantify response to prokinetic therapy and to individualize treatment regimens for patients with dyspepsia who have specific psychologic or behavioral characteristics.

Topics: Adult; Aged; Attitude to Health; Cisapride; Domperidone; Dyspepsia; Female; Gastrointestinal Agents; Gastrointestinal Motility; Humans; Male; Middle Aged; MMPI; Personality Inventory; Piperidines; Prospective Studies; Quality of Life

Topics: Abdominal Pain; Anti-Ulcer Agents; Cisapride; Dyspepsia; Esophagitis, Peptic; Humans; Piperidines

Assessment of gastric emptying time by ultrasonography is increasingly used to evaluate gastroparesis. At first normal values have to be defined. In 20 healthy volunteers the upper value of half emptying time after a semisolid meal was 50 min. A good correlation of gastric emptying time evaluated by scintigraphy was found. Diabetics with autonomous neuropathy had a remarkable delay in gastric emptying, not seen in patients with functional dyspepsia. In dyspeptic patients pathologic width of the antrum (measured by planimetry after overnight fasting) decreased during therapy with cisapride in correlation to the improvement of symptoms.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cisapride; Diabetic Neuropathies; Dyspepsia; Female; Gastric Emptying; Gastroparesis; Humans; Male; Middle Aged; Piperidines; Reference Values; Sympathomimetics; Ultrasonography

[13C]Acetate and [13C]octanoate breath tests were used to analyze the gastric emptying of liquids and solids in healthy controls and patients with functional dyspepsia both with and without cisapride. A standard test meal was labeled with either 150 mg [13C]acetate (liquid phase labeled in the water) or with 100 mg [13C]octanoate (solid phase labeled in the egg yolk). Six patients with dyspepsia and six healthy controls underwent a 4-hr breath test four times, ie, both the [13C]acetate and [13C]octanoate test with and without cisapride. Duplicate [13C]acetate or [13C]octanoate breath tests were performed in another 12 healthy controls in order to assess day-to-day variability of gastric emptying for liquids and solids. The mass spectrometric data were fitted to a power exponential function allowing mathematical analysis of half-emptying times and lag times. In patients with dyspepsia, gastric half emptying times of solids were significantly delayed as compared to the emptying of solids in the controls (203 +/- 41 vs 148 +/- 35 min; P < 0.05). With cisapride, gastric emptying of solids was significantly accelerated (P < 0.05) both in the patients (166 +/- 58 min) and in the controls (117 +/- 27 min). The gastric emptying of liquids did not differ in patients and controls, and cisapride had no effect on the emptying of liquids within the normal range. In the healthy controls, half emptying times both for liquids and solids were reproducible on the two different days (CVintra: 5.58% for liquids, 20.01% for solids).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acetates; Adult; Anti-Ulcer Agents; Breath Tests; Caprylates; Carbon Isotopes; Cisapride; Dyspepsia; Female; Gastric Emptying; Humans; Least-Squares Analysis; Male; Middle Aged; Piperidines; Reference Values; Statistics, Nonparametric

We examined the effect of oral cisapride on gastric emptying time and myoelectrical activity using real-time ultrasonography and cutaneous electrogastrography in 10 children with nonulcer dyspepsia. A clear dominant frequency close to 3 cpm was present both at baseline and after eight weeks of cisapride. After cisapride, nine children had an increase in the normal slow wave percentage and the mean percentage of normal slow wave was significantly different (71.90 +/- 5.19% vs 79.16 +/- 5.54%; P < 0.01). Moreover, an increased stability of the dominant frequency, determined by computing the coefficient of variation before and after cisapride, was found (28.12 +/- 1.72% vs 23.61 +/- 3.47%; P < 0.01). At baseline the gastric emptying time, expressed as T1/2, was 139.76 +/- 40.04 min and at eight weeks 119.76 +/- 30.04 min (P = 0.06). As regards the relationship between EGG and gastric emptying, the proportion of children with improved normal slow wave percentage was similar to that with improved T1/2 emptying (Z = 0.57, P = 0.57). Thus, gastric electrical activity seems to be an important factor in the pathophysiology of nonulcer dyspepsia in children.

Topics: Adolescent; Child; Child, Preschool; Cisapride; Dyspepsia; Electrophysiology; Female; Gastric Emptying; Humans; Male; Piperidines; Stomach; Ultrasonography

Topics: Cisapride; Domperidone; Dyspepsia; Gastroesophageal Reflux; Gastroparesis; Humans; Metoclopramide; Piperidines; Serotonin Antagonists

Topics: Animals; Cisapride; Dyspepsia; Gastrointestinal Motility; Humans; Piperidines

Topics: Adult; Anorexia Nervosa; Body Image; Body Weight; Cisapride; Dyspepsia; Female; Gastric Emptying; Hong Kong; Humans; Piperidines; Serotonin Antagonists; Somatoform Disorders

This paper identifies the symptom profile associated with the four main diagnoses of functional digestive disorders (dyspepsia, gastro-oesophageal reflux disease (GORD), gastritis, and constipation) made by general practitioners in Belgium. Results are also presented from a multicentre study in which the effects of cisapride, administered as an oral tablet or suspension, were evaluated in patients with these functional digestive disorders. Analysis of symptom patterns revealed that early satiety and postprandial abdominal bloating were the most prominent symptoms, followed by eructation (belching), heartburn, regurgitation, postprandial epigastric burning or discomfort, and nausea. These symptoms occurred in all diagnostic groups. However, different symptom patterns were associated with each of the disorders; for example, heartburn and regurgitation were the core symptoms in patients diagnosed as having GORD, early satiety and abdominal bloating were characteristic of patients diagnosed with dyspepsia, and fasting or postprandial pain were characteristic of patients given the diagnosis of gastritis. Therefore, it appears that these diagnoses used by general practitioners in Belgium closely correspond to reflux-like, dysmotility-like and ulcer-like dyspepsia, as defined by an international working party. Cisapride improved the core symptoms in about 80% of patients with GORD or dyspepsia, relieved all epigastric symptoms in about 80% of patients with gastritis, and significantly decreased the use of laxatives and increased stool frequency in constipated patients. Cisapride was well tolerated and thus appears to be a useful option in the treatment of functional digestive disorders in a general practice setting.

Topics: Adult; Aged; Belgium; Cisapride; Cluster Analysis; Constipation; Dyspepsia; Family Practice; Female; Follow-Up Studies; Gastritis; Gastroesophageal Reflux; Gastrointestinal Diseases; Gastrointestinal Motility; Humans; Male; Middle Aged; Piperidines; Treatment Outcome

In a 28-day non-blinded study of 1071 patients with functional dyspeptic symptoms in a general practice setting, 666 presented with mainly typical symptoms of functional dyspepsia and received 5 mg cisapride three times daily, while 405 with predominating symptoms indicative of gastroesophageal reflux received 10 mg cisapride three times daily. On the basis of an anamnestic risk factor analysis for organic lesions, 'low-risk' patients were to be treated directly with cisapride, while for 'high-risk' patients a more thorough gastrointestinal examination was recommended before starting cisapride. Of patients in the dyspepsia group 75% reported a good or excellent response; the corresponding rate was 80% in the reflux group. Low-risk patients in both groups tended to respond better than high-risk patients (mean difference, 11%). Patients and investigators reached identical assessments of response. Concomitant antacids, calcium antagonists, beta-blockers and sedatives did not affect the results, but concomitant NSAIDs reduced the mean improvement rate by 14% (p < 0.01). Adverse effects such as abdominal cramps and loose stools were uncommon (< or = 3.4%).

Topics: Cisapride; Drug Therapy, Combination; Dyspepsia; Female; Gastrointestinal Motility; Humans; Male; Middle Aged; Piperidines; Risk Factors; Treatment Outcome

In 240 patients with symptoms of dyspepsia, recruited consecutively and investigated in 12 hospitals in Japan, 24.2% were diagnosed having organic dyspepsia; 75.8% had functional dyspepsia, of whom 63.2% were diagnosed by the investigator having dysmotility-like, 13.7% ulcer-like, 11.5% reflux-like, and 11.5% non-specific dyspepsia. There was, however, considerable overlap of symptom profiles. Cisapride therapy initiated in functional dyspeptic patients resulted in moderate or marked improvement in 79.1% of the patients with the highest response rates for dysmotility-like (85.2%), reflux-like (81.0%), and non-specific dyspepsia (76.1%) (versus 52.0% for ulcer-like dyspepsia).

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Cisapride; Dyspepsia; Female; Gastrointestinal Motility; Humans; Japan; Male; Middle Aged; Piperidines; Treatment Outcome

An open prospective drug monitoring study was undertaken to assess the efficacy and tolerability of 5 mg cisapride three times daily in 37,925 general practice patients with functional dyspepsia. Short-term (mean, 4 weeks) cisapride treatment was associated with a significant reduction in overall dyspeptic symptom scores and improvements in scores of all eight individual dyspeptic symptoms (epigastric discomfort, fullness, nausea, bloating, heartburn, acid regurgitation, loss of appetite, and vomiting). Physician's and patient's subjective global evaluations of antidyspeptic efficacy were good or very good in 80% to 90% of cases. The tolerability of cisapride was judged to be satisfactory, good or very good in approximately 95% of patients, with adverse drug reactions being documented in 4.8% of patients. Of these, diarrhea/loose stools (2.5% of all patients) and headache (0.7%) were most frequent. Premature treatment withdrawal due to poor tolerability was necessary in only 0.35% of patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Cisapride; Drug Monitoring; Dyspepsia; Family Practice; Female; Gastrointestinal Motility; Humans; Infant; Infant, Newborn; Male; Middle Aged; Piperidines; Prospective Studies; Treatment Outcome

Quality of life measures have received little attention in evaluation of therapy for dyspepsia. To examine the effect of cisapride on gastrointestinal symptoms and quality of life measures, we studied eight patients with chronic, severe dyspepsia, before and after therapy with cisapride (20 mg three times daily) for 12 months. Gastrointestinal (GI) Total Symptom Score (TSS), Overall Patient Assessment (OPA), and quality of life by both trait (Minnesota Multiphasic Personality Inventory (MMPI)) and physical function (Sickness Impact Profile (SIP)) were measured at base line and at month 12 of cisapride therapy. Results showed significant improvement in TSS, OPA, and the MMPI Depression and Anxiety scales (all, p < 0.05). Improvement in the SIP physical dimension score approached significance (p = 0.065). We conclude that, in this group of patients with severe dyspepsia, both GI symptoms and quality of life measures improved with 12 months of cisapride therapy. These quality of life measures may prove useful in evaluating the efficacy of drug treatment for dyspepsia.

Topics: Adult; Aged; Cisapride; Dyspepsia; Female; Gastrointestinal Motility; Humans; Male; Middle Aged; MMPI; Piperidines; Quality of Life; Severity of Illness Index

Three children (ages 5, 7.6, and 8 years), with recurrent unexplained upper abdominal symptoms such as vomiting, epigastric pain, anorexia, early satiety and without structural or mucosal abnormalities of gastrointestinal tract, underwent electrogastrography (EGG)--recording of gastric electrical activity using cutaneous electrodes positioned on the epigastric region and connected to a recording polygraph. Frequency of EGG signals was analyzed by fast Fourier transform. Significant changes of fasting and fed gastric myoelectrical activity (tachygastria, bradygastria, flatline pattern) were recorded in the three patients; furthermore, gastric emptying (GE) of a solid-liquid mixed meal, measured by ultrasonography, was significantly prolonged in them. A follow-up study was carried out after an eight-week course with oral cisapride: in all patients symptoms improved, GE time normalized, and EGG analysis showed normal electrical rhythm. It is suggested that gastric dysrhythmias can play a pathogenetic role in patients with functional gastrointestinal symptoms and that symptomatic improvement is accompanied by normalization of gastric electrical rhythm.

Topics: Child; Child, Preschool; Cisapride; Dyspepsia; Female; Fourier Analysis; Gastric Emptying; Humans; Male; Monitoring, Physiologic; Myoelectric Complex, Migrating; Piperidines; Serotonin Antagonists; Signal Processing, Computer-Assisted

Topics: Cisapride; Dyspepsia; Humans; Piperidines

The 24-hr gastric and duodenal pressure measurement was performed in 5 patients with non-ulcer dyspepsia (NUD). The reduction of incidence of IMC and prolongation of the first appearance of IMC after evening meal were observed in NUD patients. The gastroprokinetic agent, cisapride 5 mg, 3 times a day for 7 days significantly increased the incidence of IMC and shortened the time before the first appearance of IMC after evening meal. This result indicates that in NUD patients impaired gastrointestinal motility is present in fasting phases and cisapride may be useful for correcting motility disorders.

Topics: Aged; Cisapride; Dyspepsia; Female; Gastrointestinal Motility; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Monitoring, Physiologic; Piperidines

To estimate the effect of a new gastroprokinetic agent, N-[4-[2-(dimethylamino)ethoxy]benzyl]-3,4-dimethoxybenzamide hydrochloride (HSR-803), on non-ulcer dyspepsia, the influence of HSR-803 on gastrointestinal propulsion was assayed in dogs, rats and mice in comparison with some gastroprokinetic agents. HSR-803 (30 mg/kg, p.o.) significantly enhanced gastric emptying in dogs, and it significantly improved the delayed gastric emptying induced by dopamine (0.4 mg/kg, i.p.) and morphine (1 mg/kg, s.c.) in rats. Metoclopramide (30 mg/kg, p.o.) also significantly restored the dopamine-induced delay, but at a dose of 10 mg/kg, p.o., it enhanced the morphine-induced delay in gastric emptying in rats. HSR-803 (10-100 mg/kg, p.o.) increased small intestinal transit in mice in a dose-dependent manner, and the effect was abolished by atropine (0.3 mg/kg, i.p.). Metoclopramide also increased small intestinal transit, but domperidone and cisapride had no effect. In delayed small intestinal transit in mice, HSR-803 (10-100 mg/kg, p.o.) improved the morphine (0.3 mg/kg, s.c.)-induced delay in a dose-dependent manner. In conclusion, because of the promotion of normal and delayed gastrointestinal propulsion, HSR-803 seems to be a promising gastroprokinetic agent for the treatment of non-ulcer dyspepsia. The action of HSR-803 is likely to be exerted through cholinergic stimulation.

Topics: Acetaminophen; Administration, Oral; Animals; Benzamides; Benzyl Compounds; Cisapride; Dogs; Domperidone; Dopamine; Dyspepsia; Female; Gastric Emptying; Gastrointestinal Motility; Male; Metoclopramide; Mice; Piperidines; Rats; Rats, Inbred Strains; Stimulation, Chemical

Topics: Acetylcholine; Adenosine Triphosphate; Adult; Cisapride; Domperidone; Drug Therapy, Combination; Dyspepsia; Female; Gastric Acid; Gastric Emptying; Humans; Male; Middle Aged; Piperidines

Topics: Cisapride; Dyspepsia; Gastric Emptying; Gastroesophageal Reflux; Humans; Intestinal Pseudo-Obstruction; Piperidines; Serotonin Antagonists

Topics: Acetylcholine; Cisapride; Dyspepsia; Gastric Emptying; Gastroesophageal Reflux; Gastrointestinal Motility; Humans; Peptic Ulcer; Piperidines; Serotonin Antagonists

Topics: Acetylcholine; Cisapride; Dose-Response Relationship, Drug; Dyspepsia; Gastric Emptying; Gastroesophageal Reflux; Humans; Myenteric Plexus; Piperidines; Serotonin Antagonists; Stomach

Topics: Adult; Aged; Cisapride; Constipation; Dyspepsia; Female; Humans; Intestinal Pseudo-Obstruction; Male; Middle Aged; Pilot Projects; Piperidines; Prospective Studies; Simethicone

The effect of the new gastrokinetic agent cisapride on gastric emptying was evaluated in 17 dyspeptic patients using the dual radionuclide technique. Eight patients with idiopathic dyspepsia and nine postsurgical dyspeptic patients were studied and compared to a control group. Gastric emptying of solids and liquids was determined after ingestion of a standardized meal using 99mTc-sulfur colloid scrambled eggs as the solid phase and [111In]DTPA-labeled water as the liquid phase. Following a basal study and on a separate occasion, each patient received an intravenous bolus of 10 mg of cisapride after ingestion of the test meal; 10 of the patients were restudied after a two-week period of chronic oral administration of the drug (10 mg four times a day). Baseline gastric emptying of solids was significantly delayed in idiopathic and postsurgical patients; liquid emptying was only delayed in the postsurgical group. Intravenous and oral administration of cisapride significantly shortened gastric emptying in both groups. In all but one patient, the clinical improvement was confirmed by the test. Cisapride appears to be a good alternative to metoclopramide and domperiodone in the treatment of dyspeptic patients. The dual radionuclide technique appears to be a useful physiologic tool for evaluating and predicting the efficacy of a gastric prokinetic therapy in man.

Topics: Adult; Cisapride; Dyspepsia; Female; Gastric Emptying; Humans; Indium Radioisotopes; Male; Middle Aged; Pentetic Acid; Piperidines; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Aged; Cisapride; Dyspepsia; Female; Humans; Male; Middle Aged; Piperidines; Powders

Topics: Acetylcholine; Acetylcholinesterase; Antiemetics; Benzimidazoles; Domperidone; Dyspepsia; Enzyme Inhibitors; Humans; Neuromuscular Junction; Peristalsis; Piperidines; Receptors, Dopamine; Vomiting

Twenty chronic schizophrenic inpatients who were being treated with high doses of neuroleptics and of whom seven had extra-pyramidal symptoms in spite of anti-Parkinsonian therapy, were given oral domperidone (50 mg t.d.s. for 2 weeks) for the relief of chronic dyspepsia. The dyspepsia symptoms were markedly improved, no side effects were seen and, even at high doses, domperidone did not intensify the existing extra-pyramidal side effects of the neuroleptics or produce new ones.

Topics: Adult; Aged; Antiemetics; Antipsychotic Agents; Benzimidazoles; Drug Interactions; Dyspepsia; Humans; Middle Aged; Piperidines; Schizophrenia

Topics: Benzimidazoles; Chemical Phenomena; Chemistry; Chronic Disease; Dyspepsia; Gastrointestinal Motility; Humans; Piperidines

The new potent anti-nauseant 5-chloro-1-(1p[3-(2,3-dihydro-2-oxo-1H-benzimidazol-1-yl)-propyl]-4-piperidinyl)-1.3-dihydro-2H-benzimidazol-2-one (domperidone), which in contrast to available anti-emetics does not provoke extrapyramidal or adrenolytic adverse effects, also enhances gastric emptying motility. Controlled clinical trials have confirmed its prokinetic effects on the stomach and its lack of side-effects, even at high doses. This anti-nauseant appears to be a safe and effective treatment for patients, both adults and children, with dyspepsia or vomiting.

Topics: Animals; Antiemetics; Benzimidazoles; Dogs; Dyspepsia; Gastric Emptying; Gastrointestinal Motility; Guinea Pigs; Humans; In Vitro Techniques; Piperidines; Rats; Vomiting