OPEN-LABEL STUDY OF LONG-TERM EFFECTIVENESS OF CISAPRIDE IN PATIENTS WITH IDIOPATHIC GASTROPARESIS

Cisapride induces acetylcholine release in cells of the myenteric plex us, thus promoting gastrointestinal motility. We studied the effects o f cisapride on 11 patients with idiopathic gastroparesis. All had nega tive gastrointestinal endoscopy, normal glucose, and took no drugs cap able of influencing motility. Most (9/11) were prior metoclopramide tr eatment failures. Patients' symptoms were scored (0-60) for pain, sati ety, bloating, nausea, vomiting, and heartburn. All underwent a solid gastric emptying study using a Technetium-99-labeled egg meal and rece ived placebo prior to cisapride. There were 10 females and one male wi th a mean (+/- SE) age of 37.8 +/- 2.6 years. Disease duration was 7.9 +/- 2.8 years. The dose of cisapride was 30-60 mg/day and the duratio n of therapy was 12.6 +/- 2.6 months (range 2.5-25 months). The sympto m score improved on cisapride from 30.9 +/- 3.6 to 14.4 +/- 2.7 (P < 0 .002 signed rank test). Emptying half-time improved from 113 +/- 4 min to 94 +/- 6 min, and 46.9 +/- 2.4% food remaining at 120 min decrease d to 35.5 +/- 3.6% (both P < 0.05). Emptying half-time in normals was 68 +/- 5 min with 16.9 +/- 2.9% remaining at 120 min. Nine of 11 patie nts gained weight, with a mean increase of 6.7 +/- 1.6 lb (range 2-12 lb). We conclude that cisapride significantly reduces gastrointestinal symptoms and promotes weight gain in patients with idiopathic gastrop aresis and is associated with improvement in solid gastric emptying. T he drug is useful in patients who previously failed metoclopramide.