Related Experiment Videos
Metoclopramide in gastroesophageal reflux of infancy
H M Machida1, D A Forbes, D G Gall
1Division of Paediatric Gastroenterology and Nutrition, Alberta Children's Hospital, Calgary, Canada.
Insights
Metoclopramide increased lower esophageal sphincter (LES) pressure in infants but also worsened gastroesophageal reflux (GER) symptoms and irritability. Further studies are needed to reconsider its use in infant GER treatment.
Area of Science:
- Pediatric Gastroenterology
- Pharmacology
Background:
- Gastroesophageal reflux (GER) is common in infants.
- Metoclopramide is sometimes used to manage GER symptoms.
Purpose of the Study:
- To evaluate the effect of metoclopramide on lower esophageal sphincter (LES) pressure and GER parameters in infants.
- To assess the efficacy and safety of metoclopramide in a double-blind, placebo-controlled trial.
Main Methods:
- Esophageal manometry and 24-hour pH monitoring were used before and after metoclopramide administration.
- Infants received intravenous and oral metoclopramide.
- A 6-month double-blind, placebo-controlled trial was conducted.
Main Results:
- Metoclopramide significantly increased end-expiratory LES pressure.
- A significant increase in the number of reflux episodes per 24 hours was observed.
- Infants receiving metoclopramide in the controlled trial showed symptom exacerbation and irritability, leading to withdrawal.
Conclusions:
- Metoclopramide's use in treating infant GER requires reconsideration due to increased reflux episodes and adverse effects.
- The drug did not improve GER duration or severity despite increasing LES pressure.
Abstract:
This study examined the effect of metoclopramide on lower esophageal sphincter (LES) pressure, and frequency and duration of reflux episodes in 28 children (mean age (+/- SD) 9 +/- 11 months) referred for evaluation of gastroesophageal reflux (GER). Esophageal manometry was performed before and after one intravenous dose of metoclopramide (0.125 mg/kg), and esophageal pH was monitored over a 24-hour baseline period, followed by oral metoclopramide therapy (0.125 mg/kg four times a day, for 24 hours.) During pH monitoring, patients received diet for age and were kept in the prone position with the head elevated 45 degrees while sleeping. Eight patients entered a 6-month double-blind, placebo-controlled trial of metoclopramide. Metoclopramide significantly (P = 0.04) increased end-expiratory LES pressure, from 14.9 +/- 7.5 mm Hg to 18.6 +/- 6.8 mm Hg. However, there was a significant (P less than 0.05) increase in the number of reflux episodes/24 hours, and no significant change in percentage of time pH was less than 4, number of episodes lasting greater than 5 minutes, or the longest episode of reflux between the 24-hour baseline and M periods. LES pressure did not correlate well with any of these measurements (r = 0.2). In the controlled trial, the three patients receiving metoclopramide, but none of those receiving placebo, were withdrawn by their parents because of exacerbation of GER symptoms and marked irritability (P = 0.01). In the placebo group, symptoms improved in four infants, but did not change in one. The use of metoclopramide in the treatment of GER of infancy needs to be reconsidered.