Lack of effect of Helicobacter pylori on symptom improvement with a prokinetic medication, cisapride, in patients with non-ulcer dyspepsia.

OBJECTIVE: This study was undertaken to determine whether H. pylori infection has an effect on the improvement of dyspeptic symptoms in response to a prokinetic agent, cisapride, in patients with non-ulcer dyspepsia (NUD). MATERIAL AND METHOD: 35 NUD patients (16 M, 19 F) who had no underlying medical condition and negative upper endoscopy were included in the present study. Each patient received a 2-wk treatment of cisapride (Prepulsid, 10 mg, tid ac). H. pylori infection was determined using a rapid urease test (CLO test). Gastric emptying (GE) scintigraphy and dyspeptic symptom scores were evaluated before and at the end of the treatment. GE was evaluated in 22 healthy volunteers as normal controls. RESULTS: Half time (T1/2) GE of NUD patients was 90.9 +/- 28 min which was significantly longer than controls (77.6 +/- 14 min; p < 0.05) and was shortened to 73.6 +/- 22 min (p < 0.0001) at the end of the treatment. Cisapride significantly improved total dyspeptic symptom scores [7 (2-18) to 3 (0-11), p < 0.0001]. The symptom score improvement was not affected by H. pylori infection [H. pylori positive: 6 (2-18) to 2.5 (0-9), p < 0.0001; H. pylori negative: 9 (4-16) to 3 (0-11), p < 0.0001] or GE status [delayed GE: 10 (5-16) to 3 (15), p < 0.05; non delayed GE: 6 (2-18) to 2 (0-11); p < 0.0001]. CONCLUSIONS: Cisapride improves dyspeptic symptoms regardless of H. pylori and GE status. These results suggest that gastric emptying and H. pylori infection are not essential to determine prior to prescribing a prokinetic agent, cisapride, in patients with NUD.

La cisaprida no altera el intervalo Q-T prolongado en pacientes con cirrosis hepática / Cisapride does not modify prolonged Q-T interval in patients with liver cirrhosis

Background: Abnormal small bowel motility, observed in liver cirrhosis, can be reversed with cisapride. Since both cisapride and liver disease are associated with prolonged QT interval, the possibility of adverse cardiovascular effects might be expected with cisapride treatment in these patients. Aim: To evaluate QT interval and other electrocardiographic changes during long term treatment with cisapride in cirrhotic patients. Patients and methods: Forty seven cirrhotic patients were studied. Electrocardiogram was recorded and the QT interval corrected according to Bazzett's formula was determined (normal value <0.44 s). Seventeen patients were treated with cisapride, 10 mg tid for seven months and electrocardiographic controls were performed at the end of the treatment. Results: The mean corrected QT interval was 0.46 ñ 0.03 s (range 0.4-0.53). 34 patients (64 percent) had QTc prolongation (0.47 ñ 0,02 s). Statistically significant higher values of QTc were observed in patients at Child Pugh stage B and C compared to stage A. No statistically significant difference according to the etiology of liver disease, were observed. No changes in mean QTc duration were observed during cisapride treatment. Conclusions: In spite that a prolonged QTc was a frequent finding in our serie of selected patients, no cardiovascular adverse effects were observed with long term cisapride treatment