A double-blind placebo-controlled study on prophylactic use of cisapride on feed intolerance and gastric emptying in preterm neonates.

OBJECTIVE: To evaluate whether prophylactic use of cisapride will reduce the incidence of feed intolerance and gastro-esophageal reflux, and improve gastric emptying in early neonatal period in preterm babies. DESIGN: Double blind randomized controlled trial. SETTING: Hospital based. SUBJECTS: Forty nine preterm babies between 29-34 weeks of gestation were administered either cisapride or placebo. METHODS: Babies were enrolled in the study once they reached 30 ml/kg/day of enteral feeding or when 25% of total fluid intake was received through the enteral route. Those with sepsis, congenital malformations and on aminophylline were excluded. The subjects were randomized to receive either cisapride or placebo in a dose of 0.2 mg/kg/dose every 8 hourly for 14 days or till discharge. During the study period babies were observed for clinical signs of feed intolerance as judged by increase in abdominal girth, increased prefeed gastric residuals or vomiting. Gastro-esophageal reflux and gastric emptying time was assessed by Technetium phytate scan on day 7 +/- 1. RESULTS: Feed intolerance was noticed in 59% of study and 41% of control population. No significant difference was noticed in the two groups in the total number of episodes of feed intolerance (1.54 +/- 2.4 vs 1.18 +/- 1.6). Nearly 50% of babies in each group had gastro-esophageal reflux. Gastric emptying time (mean (SD) and median) was found to be comparable (p = 0.70) in those on drug and placebo (58.1 (32.2 min) 48.8 min) vs (53.8 (34.6 min) 43.4 min). CONCLUSION: Cisapride does not reduce the incidence of feed intolerance, gastro-esophageal reflux and does not improve gastric emptying in normal preterm neonates.

Tratamiento de síntomas dispépticos con un nuevo inhibidor de la bomba de protones, rabeprazol sódico (pariet 20 mg diarios) / Rabeprazole in dispeptic syndrome. Preliminar report of a multicentric study

La dispepsia funcional es un padecimiento caracterizado por dolor crónico o recidivante en el abdomen superior relacionado con las comidas sin evidencia de enfermedad orgánica gastrointestinal. El objetivo del estudio fue valorar la eficacia y seguridad de rabeprazol sódico a dosis de 20 mg diarios en el tratamiento de la dispepsia funcional durante un mes de tratamiento. El estudio fue prospectivo, abierto, multicéntrico, que incluyó 108 pacientes con sintomatología dispéptica de moderada a severa de más de un mes de evolución, con un estudio endoscópico normal. Los pacientes fueron evaluados al final del tratamiento y cuatro semanas después. A los 56 días después del inicio del tratamiento de los pacientes tanto el dolor abdominal así como la plenitud postprandial y otra sintomatología como las agruras, regurgitación o ardor en epigastrio estuvieron ausentes en el 95 por ciento de los casos. Eventos adversos presentes en sólo tres pacientes: boca amarga en dos y cefalea en 1. Se concluye que rabeprazol sódico es eficaz y seguro en pacien-tes con dispepsia funcional.

Intestinal pseudo-obstruction due to neurofibromatosis responding to cisapride.

Gastrointestinal involvement in neurofibromatosis presenting with mechanical obstruction, hemorrhage or intussusception is known. Small bowel dysmotility and intestinal pseudo-obstruction due to neurofibromatosis is rare. A 23-year-old man with classical neurofibromatosis presented with intermittent episodes of intestinal pseudo-obstruction, small bowel bacterial overgrowth and steatorrhea. The patient had good symptomatic improvement with cisapride.

Reflujo gastroesofágico: un intento de clarificar conceptos / Gastroesophageal reflux: an attempt to clarify concepts

EL reflujo gastroesofágico (RGE) es uno de los temas de gastroenterología pediátrica que tal vez suscite mayor controversia.pese a las numerosas publicaciones aparecidas en los últimos años, persiste aún bastante confusión respecto a sus aspecto conceptuales y prácticos, lo que se traduce con frecuencia en un manejo inadecuado de los pacientes que lo presentan. La mayor confusión conceptual deriva de la dificultad de discriminar entre lo que constituye un reflujo fisiológico de uno patológico. La existencia de numerosas técnicas de estudios que se han desarrollado en los últimos años indica que ninguna de ellas es completamente satisfactoria; por otra parte la utilización de dicha técnicas no siempre es más adecuada. En el presente artículo se hace una discusión crítica del tema en relación a los aspectos conceptuales, patogénicos, diagnósticos y terapéuticos, en base a las publicaciones más recientes aparecidas en la literatura médica

Double blind controlled trial of effect of cisapride on gastric emptying in diabetics.

AIMS: Diabetic gastroparesis is a common complication seen in 20-50% of patients due to autonomic neuropathy involving vagal supply. Cisapride, a specific gastrointestinal cholinomimetic agent may thus be effective. METHODS: Fifty-one diabetic patients (age 12-65 years) of disease duration > 5 years were assessed for symptomatic gastroparesis, other diabetic complications and glycemic control. Gastric emptying time (GET) was estimated using a solid meal method (99mTc labeled rice based idli) and patients randomized to receive either cisapride or placebo for a period of 2 weeks. Cisapride was administered in a dose of 10 mg TID. GET and symptom scores were reassessed on the therapy after 2 weeks. RESULTS: Twenty nine of 51 (56.8%) patients had gastroparesis. Mean GET in the gastroparesis group was 141 +/- 66 minutes compared to 24.53 +/- 10 minutes in the non gastroparesis group (p < 0.01). GET decreased by 72% amongst the patients who received cisapride compared to 23% in the placebo group (p < 0.001). Symptom scores also improved in the cisapride group; no adverse effects were noted. CONCLUSIONS: Cisapride improves the symptom score and the solid gastric emptying time in patients suffering from diabetic gastroparesis.

Efeito da cisaprida na constipacao intestinal cronica funcional em criancas / Effect of cisapride on chronic functional constipation in children

O objetivo foi avaliar os efeitos da cisaprida no tratamento de criancas com constipacao intestinal cronica funcional (CICF). Estudaram-se 26 criancas, 10 meninas e 16 meninos com idades de...

Reflujo faringolaríngeo: una patología con identidad propia / Pharyngolaryngeal reflux: a pathology with a distinctive identity

Se presenta un grupo compuesto por 70 pacientes portadores de síntomas atribuibles a reflujo faringolaríngeo y 20 pacientes controles. Se describen y proponen 3 estadios clínocos nasofibroscópicos de la enfermedad y se correlacionan con los síntomas digestivos, broncopulmonares y faringolaríngeos en los pacientes y controles. En los 70 pacientes se analizan los resultados del tratamiento médico propuesto, siendo bueno en el 88,4 por ciento de los casos y regular en 11,6 por ciento

A study of gastric emptying in chronic renal failure.

In a prospective controlled study, 32 patient with chronic renal failure (CRF) and 11 healthy volunteers were evaluated for solid gastric emptying at our institute over a period of 2 years. The study sought to identify the incidence of abnormal gastric emptying in these patients, the factors influencing the development of abnormal gastric emptying and whether gastrointestinal symptoms correlated with abnormal gastric emptying. The efficacy of prokinetic drugs Cisapride and Erythromycin in improving delayed gastric emptying in these patients with CRF was also compared and evaluated. We observed delayed gastric emptying in 69% of our patients. About 50% of our patients with delayed gastric emptying had no gastrointestinal symptoms suggesting a poor correlation between the two. Delayed gastric emptying was observed frequently in patients with peripheral neuropathy and/or autonomic neuropathy. Gastric emptying in CRF appears to be independent of age, sex, duration of disease, BUN, creatinine and H. phylori infection. Oral Cisapride and Erythromcin are effective gastrokinetic agents in these patients. Identification of delayed gastric emptying in patients with CRF and treatment with these drugs may reduce gastrointestinal symptom related morbidity.