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Prokinetics and reflux: a promise unfulfilled
1Department of Gastroenterology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK. john.decaestecker@uhl-tr.nhs.uk
European Journal of Gastroenterology & Hepatology
|January 10, 2002
Summary
Gastro-oesophageal reflux disease (GORD) is a motility disorder. While cisapride offers modest benefits for GORD, more effective prokinetic agents are needed, especially as adjuncts to acid suppression therapy.
Area of Science:
- Gastroenterology
- Pharmacology
Background:
- Gastro-oesophageal reflux disease (GORD) is characterized by upper gastrointestinal motility disturbances, including lower oesophageal sphincter (LES) function, oesophageal body motility, oesophageal clearance, and gastric emptying.
- Cisapride, a prokinetic agent, has shown modest clinical benefits in improving these parameters.
Discussion:
- Recent studies suggest cisapride's efficacy may be overestimated, with limited impact on transient LES relaxations and diaphragmatic crus function.
- The agent does not address mechanical factors influencing gastro-oesophageal junction competence, such as LES length and intra-abdominal pressure effects.
Key Insights:
- Cisapride's benefits in GORD are modest and do not fully address the complex pathophysiology of the condition.
- There is a significant need for more potent, specific, and predictable prokinetic agents to manage GORD effectively.
Outlook:
- Novel prokinetic agents are desirable, but are unlikely to be effective as monotherapy for the full spectrum of GORD.
- Such agents, including cisapride, may serve as valuable adjuncts to acid suppression in refractory GORD cases.