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Effect of prokinetics in children with recurrent nocturnal retrosternal pain
B Hegar1, S de Pont, K Vandemaele
1Academisch Ziekenhuis Kinderen, Vrije Universiteit Brussel, Brussels, Belgium.
Insights
Cisapride effectively relieved nocturnal chest pain in children by improving upper gastrointestinal motility. This study highlights cisapride as a potential treatment for recurrent epigastric pain in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Pharmacology
Background:
- Recurrent nocturnal retrosternal or epigastric pain in children is uncommon and may stem from upper gastrointestinal dysmotility, such as gastro-oesophageal reflux.
- Investigating the etiology of such symptoms is crucial for effective pediatric patient management.
Purpose of the Study:
- To assess the clinical efficacy of prokinetics, specifically cisapride, in managing recurrent nocturnal retrosternal pain in children.
- To objectively measure cisapride's effects using combined esophageal 24-hour pH and pressure monitoring.
Main Methods:
- A single-blinded prospective study involving 12 children (mean age 9.5 years) with chronic nocturnal retrosternal pain.
- Participants underwent alternating periods of cisapride administration and placebo, with clinical assessments and esophageal pH/pressure monitoring.
Main Results:
- Cisapride provided temporary symptom relief in 10 out of 12 children.
- Objective improvements included normalized esophageal pH monitoring and enhanced lower esophageal contractions (increased amplitude and duration).
Conclusions:
- Cisapride demonstrates a positive clinical effect on recurrent nocturnal retrosternal pain in pediatric patients.
- The findings support cisapride's role in improving symptoms related to upper gastrointestinal dysmotility in children.
Background:
Children rarely present with vague complaints of nocturnal recurrent retrosternal or upper-abdominal, epigastric, pain. Dysmotility of the upper gastrointestinal tract, including gastro-oesophageal reflux, might be at the origin of these manifestations.
Objective:
To evaluate the clinical effect of prokinetics (cisapride) in children with recurrent nocturnal retrosternal pain, and to measure the effect of cisapride with a combined oesophageal ambulatory 24 h pH and pressure monitoring.
Patients:
Twelve children, mean age 9.5 years (range 4.1-14.0 years), with nocturnal recurrent retrosternal pain for more than 6 months, occurring at least three times a week.
Methods:
Single-blinded prospective study, with two periods of 2-3 weeks during which cisapride was administered, alternated with two placebo periods of the same duration. Clinical evaluation, and assessment with oesophageal pH and pressure monitoring.
Results:
Cisapride was related to a temporary relief of the symptoms in 10/12 children. The improvement was demonstrated through a normalization of pH monitoring, and an increase in amplitude and duration of the contractions in the lower oesophagus.
Conclusion:
Cisapride improves complaints of recurrent nocturnal retrosternal pain in children.