THE EFFECT OF CISAPRIDE IN PATIENTS WITH REFLUX ESOPHAGITIS - AN AMBULATORY ESOPHAGEAL MANOMETRY PH-METRY STUDY/

Objectives: The mechanisms responsible for the efficacy of cisapride i n gastroesophageal reflux disease remain unclear, The current study wa s designed to test the hypothesis that cisapride decreases esophageal acid exposure by augmenting esophageal motility and improving acid cle arance, Methods: Eighteen patients with reflux esophagitis underwent c ombined 24-h ambulatory esophageal manometry/pH-metry at baseline and then again after 2 wk of cisapride therapy (10 mg q.i.d.). Results: Es ophageal acid exposure was significantly decreased during cisapride th erapy (total percentage of time pH was < 4: 8.3 +/- 2.0% at baseline v s 3.5 +/- 0.6% on cisapride), This was not associated with significant changes in contraction amplitude or duration, peristaltic velocity, o r the proportion of peristaltic contractions, The number of reflux epi sodes per hour was unchanged by cisapride therapy; however, cisapride significantly decreased the number of prolonged duration reflux episod es as well as the duration of the longest reflux episode. Although the relative proportion of peristaltic versus nonperistaltic contractions occurring during reflux episodes was unchanged by cisapride therapy, there was a significant increase in the mean number of contractions pe r minute (both peristaltic and nonperistaltic combined) occurring duri ng reflux episodes, Conclusions: These data suggest that cisapride dec reases esophageal acid exposure by improving esophageal clearance and that this occurs because of an increase in the number of esophageal co ntractions rather than by augmenting contraction amplitude or duration or the proportion of peristaltic sequences.