piperidines and Postgastrectomy-Syndromes

Postgastrectomy syndromes are uncommon but, unfortunately, frustrating for both patient and physician, because treatment with prokinetic agents is often of limited benefit. This article examines the evidence for efficacy of available prokinetic drugs in the management of these difficult disorders.

Topics: Bethanechol; Bethanechol Compounds; Cisapride; Domperidone; Erythromycin; Gastric Emptying; Humans; Metoclopramide; Piperidines; Postgastrectomy Syndromes

Topics: Anemia, Pernicious; Anorexia Nervosa; Cisapride; Connective Tissue Diseases; Diabetes Complications; Domperidone; Drug-Related Side Effects and Adverse Reactions; Gastric Emptying; Gastroesophageal Reflux; Gastrointestinal Motility; Humans; Intestinal Pseudo-Obstruction; Metoclopramide; Piperidines; Postgastrectomy Syndromes; Stomach Diseases

Medical treatment of duodenogastroesophageal reflux in postgastrectomy patients has been disappointing. Using ambulatory esophageal bilirubin monitoring, we evaluated the efficacy of cisapride in this disorder. Ten chronically symptomatic partial gastrectomy patients (5 Billroth I, 5 Billroth II; 8 men; average age 57) with duodenogastroesophageal reflux were randomized to four weeks of either placebo or cisapride (20 mg four times a day) in a double-blind crossover study. Significantly improved patients continued to take cisapride for an additional four months. Duodenogastroesophageal reflux was assessed at baseline and after four weeks on each therapy. Daily diary recorded symptoms and mean monthly scores were determined. Global symptom improvements were assessed at the end of each treatment period. Compared to placebo, cisapride significantly (P < 0.05) decreased duodenogastroesophageal reflux. Overall symptom improvements were assessed at the end of each treatment period. Compared to placebo, cisapride significantly (P < 0.05) decreased duodenogastroesophageal reflux. Overall symptoms improved in 70% of patients on cisapride compared to 10% on placebo (P < 0.01). Mean monthly scores significantly (P < 0.05) improved for abdominal pain, regurgitation, and belching. These symptoms remained improved after four months of chronic therapy. We conclude that cisapride significantly reduces duodenogastroesophageal reflux and results in short- and long-term symptom improvements in postgastrectomy patients and that cisapride offers the first successful medical therapy for duodenogastroesophageal reflux in postgastrectomy patients.

Topics: Anti-Ulcer Agents; Bilirubin; Cisapride; Cross-Over Studies; Double-Blind Method; Duodenogastric Reflux; Female; Gastroesophageal Reflux; Gastrointestinal Motility; Humans; Hydrogen-Ion Concentration; Male; Manometry; Middle Aged; Monitoring, Ambulatory; Piperidines; Postgastrectomy Syndromes; Time Factors; Treatment Outcome

A computerised system for measurement of vibration at the abdominal surface was constructed which was addressed to the evaluation of gastrointestinal (GI) motor function. Preliminary studies revealed a dominant low frequency signal which was synchronous with the heartbeat and was considered representative of aortic pulsation. This was excluded by selective spectral filtration. The remaining signal was processed and measured by computer, with provision of quantitative energy values as well as of graphic display. The developed method, called surface vibration analysis (SVA) has been evaluated clinically; (a) against oral to caecal transit times (OCCT) of a standard solid meal, in five patients with severe postgastrectomy diarrhoea, seven patients with mild idiopathic diarrhoea and 22 healthy volunteers. (b) against prokinetic effects of a gastrointestinal stimulant (cisapride) in nine patients. In (a) postprandial SVA energy measurements were greater (SVA [*X (SEM)] = 406,933 (98,224] and oral to caecal transit of the solid meal was more rapid (OCTT = *90 (29) min) in the severe diarrhoea patients [postgastrectomy] than either the mild diarrhoea group (*SVA = 235,317 (50,780); *OCTT = *199 (42) min) or normal volunteers (*SVA = 212,062 (27,153); *OCTT = 242 (19) min) [p less than 0.01 for SVA and OCTT]. In the total group, an inverse correlation was observed between quantitative SVA energy values and oral to caecal transit times of solids (Spearman's rho = -0.486; p less than 0.01). In (b), drug stimulation of the GI tract caused an increase of fasting SVA measurements from *21,217 (5956) [before] to *41,937 (9606) [after] intravenous cisapride (p less than 0.05). This new technique may be useful for evaluation of gastrointestinal motor activity.

Topics: Adult; Cisapride; Diarrhea; Digestive System; Digestive System Physiological Phenomena; Gastrointestinal Motility; Gastrointestinal Transit; Humans; Microcomputers; Middle Aged; Motor Neurons; Piperidines; Postgastrectomy Syndromes; Transducers; Vibration

Topics: Biomedical Research; Colchicine; Colectomy; Colitis; Colitis, Ulcerative; Colonic Diseases; Colonic Diseases, Functional; Crohn Disease; Diabetic Neuropathies; Diarrhea; Diphenoxylate; Diverticulitis; Diverticulitis, Colonic; Drug Therapy; Dysentery; Dysentery, Amebic; Enteritis; Gastroenteritis; Humans; Piperidines; Postgastrectomy Syndromes; Postoperative Complications; Toxicology; Virus Diseases