The effect of cisapride on dysmotility-like functional dyspepsia: reduction of the fasting and postprandial area, but not of the postprandial antral expansion

Objective To test the effect of cisapride on symptom score and on fasting a nd postprandial antral area in patients with dysmotility-like functional dy spepsia compared with controls. Methods Nineteen consecutive patients with dysmotility-like functional dysp epsia (13 females, six males, aged 18-79 y) and 12 control subjects (six fe males, six males, aged 19-68 y) were investigated. A symptom score includin g six upper digestive symptoms rated from 0 to 3 was applied. The patients received in a randomized order cisapride 10 mg t.i.d, (n = 10), or placebo (n = 9) for 3 days. The controls also received cisapride (n = 6) or placebo (n = 6) in the same way. The antral area in fasting condition and immediat ely after a semiliquid test meal (250 ml, 342 kcal) was assessed by real-ti me ultrasonography in front of the aorta and mesenteric vein, The measureme nts were carried out before starting and after finishing the trials with ci sapride and placebo. Results The symptom score (mean +/-SD) was 7.1 +/- 2.4 in dysmotility-like functional dyspepsia vs 0.5 +/- 0.2 in controls (P < 0.0001). The fasting a ntral area was 4.5 +/- 0.9 cm(2) in dysmotility-like functional dyspepsia v s 2.2 +/- 0.2 cm(2) in controls (P < 0.0001). Postprandial antral area was also larger in dysmotility-like dyspepsia than in controls (6.2 +/- 1.0 vs 3.0 +/- 0.3 cm(2), P = 0.0001), Symptom score correlated with fasting antra l area in dysmotility-like functional dyspepsia (r = 0.38, P = 0.05). Cisap ride decreased the symptom score to 4.5 +/- 2.5 (P = 0.0009) and placebo to 5.3 +/- 2.4 (P = 0.02). Cisapride significantly reduced the fasting antral area and the postprandial antral area in the dyspeptic group, but not in t he control group. Postprandial antral expansion was not influenced by cisap ride. Placebo did not change the sonographic parameters in both groups. Conclusions In dysmotility-like functional dyspepsia, fasting and postprand ial antral areas are wider than in controls. Despite a good placebo respons e, cisapride is effective in improving the symptoms in dysmotility-like fun ctional dyspepsia, associated with the reduction of fasting and postprandia l antral areas. Eur J Gastroenterol Hepatol 10: 991-995 (C) 1998 Lippincott Williams & Wilkins.