ABSTRACT
BACKGROUND: Intravenous (i.v.) erythromycin enhances gastric emptying and oesophageal motility in both healthy and disease situations, acting either as a motilin or acetylcholine agonist. The purpose of the present paper was to investigate any possible effect of i.v. erythromycin on oesophageal motility in patients with gastro-oesophageal reflux (GOR). METHODS: In 15 patients with GOR (proven on 24-h ambulatory oesophageal pH measurement), standard oesophageal manometry was performed after i.v. injection of placebo and 200 mg erythromycin, in a random blind fashion. RESULTS: Erythromycin significantly increased lower oesophageal sphincter (LOS) pressure from 17 +/- 5 to 41 +/- 10 mmHg (P < 0.001), without affecting the postdeglutition relaxation of LOS. Erythromycin also increased the amplitude (from 79 +/- 34 to 97 +/- 40 mmHg; P < 0.001), duration (from 3.4 +/- 0.6 to 3.8 +/- 0.6 s; P = 0.005), velocity (from 3.1 +/- 0.8 to 3.5 +/- 1.15 cm/s; P = 0.0047) and strength (from 149 +/- 84 to 201 +/- 103 mmHg.s; P < 0.001) of peristalsis at 5 cm proximal to the LOS. Similarly, the drug increased the amplitude of peristalsis at 10 and 15 cm proximal to the LOS (from 70 +/- 39 to 77.4 +/- 37 mmHg; P = 0.049 and from 36 +/- 20 to 49 +/- 36 mmHg; P = 0.004, respectively) and the duration of peristalsis at the same levels (from 3.1 +/- 0.6 to 3.3 +/- 0.5 s; P = 0.011, and from 2.7 +/- 0.6 to 3 +/- 0.5 s; P = 0.003, respectively). CONCLUSION: Intravenously administered erythromycin improves impaired oesophageal motility in patients with GOR. This observation might be of clinical use.
Subject(s)
Erythromycin/administration & dosage , Esophageal Motility Disorders/drug therapy , Gastric Emptying/drug effects , Gastroesophageal Reflux/drug therapy , Adult , Aged , Double-Blind Method , Erythromycin/adverse effects , Esophagogastric Junction/drug effects , Female , Gastric Acidity Determination , Humans , Injections, Intravenous , Male , Middle Aged , Monitoring, AmbulatoryABSTRACT
Impaired neorectal function or sphincter incompetence have been respectively implicated as causative factors of increased frequency of defaecation or incontinence after low anterior resection of the rectum (LARR) for rectal carcinoma, although individual mechanisms of anorectal function have not been fully studied. Functional and laboratory results were evaluated in 19 subjects, who had a LARR for rectal carcinoma before and after the procedure, and were compared to those of normal subjects. LARR worsened anorectal function, mostly by significantly increasing the daily number of defaecations (p < 0.001), while major incontinence was reported in three cases. Patients with rectal carcinoma have a decreased resting anal pressure on manometry, as compared to controls (p < 0.001). LARR further reduces anal resting pressure (p < 0.001) as well as all parameters that express internal sphincter activity, such as presence and amplitude of either slow (p < 0.05 and p < 0.01) or ultraslow waves. LARR also impaired external anal sphincter activity, as expressed by the reduction in anal squeeze pressure (p < 0.001). Anorectal sampling was found reduced in incidence and frequency in LARR patients as compared to controls (p < 0.01 and p < 0.001), and was impaired even further postoperatively (p < 0.001). Rectoanal inhibitory reflex was present in all but three patients postoperative, but significantly impaired as compared to controls. Rectal volumes to elicit transient or permanent desire to defecate, maximal tolerable rectal volume and rectal compliance were also significantly reduced after LARR (p < 0.001, p < 0.001, p < 0.01 and p < 0.001 respectively). Large bowel transit was significantly enhanced after LARR (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
