piperidines and Esophagitis

In this paper, a Working Group on Gastro-Oesophageal Reflux discusses recommendations for the first line diagnostic and therapeutic approach of gastro-oesophageal reflux disease in infants and children. All members of the Working Group agreed that infants with uncomplicated gastro-oesophageal reflux can be safely treated before performing (expensive and often unnecessary) complementary investigations. However, the latter are mandatory if symptoms persist despite appropriate treatment. Oesophageal pH monitoring of long duration (18-24 h) is recommended as the investigation technique of choice in infants and children with atypical presentations of gastro-oesophageal reflux. Upper gastro-intestinal endoscopy in a specialised centre is the technique of choice in infants and children presenting with symptoms suggestive of peptic oesophagitis. Prokinetics, still a relatively new drug family, have already obtained a definitive place in the treatment of gastro-oesophageal reflux disease in infants and children, especially if "non-drug" treatment (positional therapy, dietary recommendations, etc.) was unsuccessful. It was the aim of the Working Group to help the paediatrician with this consensus statement and guide-lines to establish a standardised management of gastro-oesophageal reflux disease in infants and children.

Topics: Child; Child Nutritional Physiological Phenomena; Cisapride; Esophagitis; Esophagoscopy; Esophagus; Europe; Gastroenterology; Gastroesophageal Reflux; Gastrointestinal Motility; Gastroscopy; Humans; Hydrogen-Ion Concentration; Infant; Pediatrics; Piperidines; Posture; Societies, Medical

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

Few studies have specifically addressed the management of the symptoms of gastro-oesophageal reflux disease, and there are no comparative data in this respect for acid pump inhibitors and prokinetic agents.. Following endoscopy 424 patients presenting with heartburn as the predominant symptom of gastro-oesophageal reflux disease were randomized to treatment with omeprazole 20 or 10 mg once daily, or cisapride 10 mg four times daily, in a double-blind, double-dummy, parallel group, multicentre study. Symptoms and quality of life were assessed at 4 weeks. Patients still experiencing heartburn continued therapy for a further 4 weeks and the assessments were repeated.. At 4 weeks, heartburn was resolved in 65% (95% CI: 57-73%), 56% (48-64%) and 41% (32%-49%) of patients treated, respectively, with omeprazole 20 mg and 10 mg once daily, and cisapride. Both omeprazole doses were significantly more effective than cisapride (P < 0.01). The same order of efficacy was observed regardless of the presence of erosive oesophagitis. Regurgitation and epigastric pain also improved to a greater degree with omeprazole than with cisapride. Quality of life was improved in all treatment groups, and the improvement in the reflux dimension of the Gastrointestinal Symptom Rating Scale (GSRS) score was significantly different between groups (P = 0.002).. Omeprazole 20 or 10 mg once daily is significantly more effective than cisapride in the resolution of heartburn, regardless of the presence of erosive oesophagitis, and this is accompanied by an improvement in patient quality of life.

Topics: Adult; Anti-Ulcer Agents; Cisapride; Double-Blind Method; Enzyme Inhibitors; Esophagitis; Female; Gastroesophageal Reflux; Heartburn; Humans; Male; Middle Aged; Omeprazole; Piperidines; Proton Pump Inhibitors; Quality of Life

In a double-blind, randomized, comparative trial of the prokinetic drug cisapride and the H2-blocker cimetidine, mucosal healing and changes in symptoms of gastroesophageal reflux were evaluated in patients with erosive reflux esophagitis. The patients were treated with either cisapride, 10 mg four times a day (N = 36) or cimetidine, 400 mg four times a day (N = 37) for six weeks, or for 12 weeks if mucosal healing was not obtained by week 6. Upon entry, two thirds of the patients in each group had grade I (Savary-Miller) esophagitis, and the remainder grade II or III. At the end of treatment, endoscopy showed mucosal healing in 56% (38-72%; 95% confidence interval) of cisapride and 57% (39-73%; 95% confidence interval) of cimetidine patients. After six weeks, both drugs significantly (P less than 0.01) decreased the intensity and frequency of heartburn, regurgitation, and the postural syndrome. No significant intergroup differences were found regarding endoscopic parameters or the improvement of heartburn and regurgitation. Concomitant antacid use was also comparable. Adverse effects were reported by four cisapride and nine cimetidine patients. These results indicate that the effects of cisapride compare well with those of cimetidine in terms of both esophageal mucosal healing and symptom relief.

Topics: Adult; Cimetidine; Cisapride; Double-Blind Method; Drug Evaluation; Esophagitis; Esophagoscopy; Female; Gastroesophageal Reflux; Humans; Male; Middle Aged; Piperidines; Random Allocation; Serotonin Antagonists

1. The inhibitory effect of sufotidine, a new histamine H2-receptor antagonist, on gastric secretion of acid and pepsin was studied in six healthy male volunteers. This was a three-way, cross-over, randomized, double-blind study. On each of 3 study days, the drug in a dose of 600 mg, or placebo, was administered either once or twice daily at 08.00 and 20.00 h. 2. The morning dose of sufotidine maintained intragastric pH above 3 until 18.00 h. Twice daily sufotidine maintained the pH above 3 throughout the 24 h. The median 24 h concentration of acid was significantly reduced from 86.9 mmol l-1 after placebo to 22.8 mmol l-1 and 4.9 mmol l-1 following the morning only or twice daily dose of sufotidine, respectively. Mean night-time output of acid was reduced by 81% after the morning dose of sufotidine and by 97% following treatment with sufotidine twice daily. 3. We conclude that sufotidine, in the doses studied, markedly inhibits gastric secretion and may therefore prove useful in the treatment of peptic ulceration and oesophagitis.

Topics: Administration, Oral; Adult; Double-Blind Method; Esophagitis; Gastric Acid; Gastric Juice; Histamine H2 Antagonists; Humans; Hydrogen-Ion Concentration; Male; Pepsin A; Piperidines; Triazoles

Topics: Cisapride; Esophagitis; Female; Humans; Infant; Piperidines; Torticollis; Trimebutine

Long-term follow-up examination with esophagogastroduodenoscopy was performed on seven patients who had undergone successful delayed anastomosis for isolated esophageal atresia. The follow-up period ranged from 1.2 to 11.3 years (mean, 5.3). All patients had undergone fundoplication because of symptomatic gastroesophageal reflux (GER). Three anastomotic strictures had to be resected. At the time of the last follow-up examination, the subjective results were excellent for five patients and good for two. The last endoscopy showed macroscopic esophagitis in three and normal mucosa in four. The fundoplication was partly disrupted in two patients. In three patients the fundoplication was competent but partly intrathoracic. Histological examination showed moderate esophagitis in one, mild esophagitis in one, and normal mucosa in five patients; however, four patients were on continuous medication for esophagitis. In conclusion, the subjective results of patients with isolated esophageal atresia treated with esophageal anastomosis are good. However, long-term complications caused by GER are common in these patients. Therefore, active search and treatment of reflux is necessary for these patients.

Topics: Anastomosis, Surgical; Anti-Ulcer Agents; Cisapride; Constriction, Pathologic; Endoscopy, Digestive System; Esophageal Atresia; Esophageal Diseases; Esophagitis; Follow-Up Studies; Fundoplication; Gastroesophageal Reflux; Gastrointestinal Agents; Humans; Infant; Piperidines; Postoperative Complications; Sucralfate

Topics: Aged; Chemical and Drug Induced Liver Injury; Cisapride; Esophagitis; Humans; Male; Piperidines; Serotonin Antagonists

There is conflicting evidence regarding whether lower esophageal sphincter and esophageal contractile pressures are affected by changes in the severity of gastroesophageal reflux disease. We compared the manometric and endoscopic findings from 30 patients before and after treatment for esophagitis. Before treatment, the grade of esophagitis (I-III) was significantly correlated (r = -0.37; p less than 0.05) with lower esophageal sphincter pressure, but not with esophageal contractile pressure. After treatment, the grade of esophagitis did not change or became worse in 15 patients, and became better in 15 patients. Of these, seven healed. The group that showed no endoscopic improvement demonstrated no change in lower esophageal sphincter or esophageal contractile pressures. The group that did show endoscopic improvement also demonstrated no increase in lower esophageal sphincter or esophageal contractile pressures, and this was particularly evident in those whose esophagitis healed. These data suggest that healing of esophagitis does not result in improvement of esophageal motor function.

Topics: Adult; Aged; Cisapride; Esophageal Motility Disorders; Esophagitis; Esophagogastric Junction; Esophagoscopy; Female; Humans; Male; Manometry; Middle Aged; Piperidines; Pressure; Ranitidine

Topics: Adult; Aged; Asthma; Biliary Tract Diseases; Dioxoles; Drug Tolerance; Duodenal Diseases; Dysmenorrhea; Esophagitis; Female; Gastritis; Heart Diseases; Humans; Kidney Calculi; Male; Middle Aged; Migraine Disorders; Muscles; Piperidines; Spasm