Prokinetic agents for the treatment of postoperative ileus in adults: A review of the literature

Metoclopramide, cisapride, and erythromycin are commonly administered to re duce the duration of postoperative ileus (POI). As these agents are not wit hout potential adverse effects, their efficacy in shortening the duration o f POI should be evaluated. The etiology of POI is not well understood and t herefore the precise treatment is unclear. Nasogastric suction is the mains tay of therapy, and management of fluid and electrolyte imbalances is cruci al. The role of prokinetic agents is less understood. Available literature evaluating these drugs specifically for POI were reviewed, but results are confounded by issues such as sample size, variability in types of operation s performed, and insensitive end points (flatus, bowel sounds). No literatu re supports reducing the duration of POI with metoclopramide, and limited d ata show benefit with cisapride. Data evaluating erythromycin are sparse, a nd the drug is believed to be ineffective. Domperidone, a prokinetic agent not available in the United States, has not been evaluated in POI. Due to t hese limitations, treatment remains largely supportive with a limited role for prokinetic agents.