COMPARISON OF CISAPRIDE AND METOCLOPRAMIDE AS ESOPHAGEAL PROKINETICS IN HEALTHY HUMANS

Objective: To compare the prokinetic potencies of equal intravenous do ses (10 mg) of cisapride and metoclopramide on oesophageal motility in healthy humans.Design: Nine male volunteers were enrolled according t o a double-blind, placebo-controlled, crossover design. Methods: In ea ch experiment, oesophageal motility was continuously recorded for 60 m in in the fasting state. Analysis of motor events was computer-assiste d. It referred to lower oesophageal sphincter pressure and relaxation, amplitude, duration, area, contractility and progression velocity of oesophageal peristalsis (wet swallows). Results: Metoclopramide hasten ed progression velocity of proximal oesophageal peristalsis by 30% (P < 0.01) compared with placebo. In the distal oesophagus, metoclopramid e raised the contraction amplitude by 9%, prolonged duration of contra ction by 11% and increased the area under the contraction by 19% (P < 0.05). Cisapride increased the amplitude by 12%, prolonged duration by 14% (P < 0.05) and raised the area by 27% (P < 0.01). Lower oesophage al sphincter pressure increased with metoclopramide (P < 0.05) and, mo re distinctly, with cisapride (P < 0.0005) compared with the basal sta te. Lower oesophageal sphincter pressure was not changed by metoclopra mide but rose by 28% with cisapride (P < 0.01) compared with placebo. Conclusions: Cisapride and metoclopramide stimulate amplitude, duratio n and the area of distal, but not proximal, oesophageal peristalis to a similar extent. Cisapride is superior to metoclopramide in raising l ower oesophageal sphincter pressure. These data support the use of cis apride as an oesophageal prokinetic.