EFFECTS OF CISAPRIDE ON SYMPTOMS AND POSTCIBAL SMALL-BOWEL MOTOR FUNCTION IN PATIENTS WITH IRRITABLE-BOWEL-SYNDROME

Background: Irritable bowel syndrome is a common cause of abdominal pa in and discomfort and may be related to disordered gastrointestinal mo tility. Our aim was to assess the effects of long-term treatment with a prokinetic agent, cisapride, on postprandial jejunal motility and sy mptoms in the irritable bowel syndrome (IBS). Methods: Thirty-eight pa tients with IBS (constipation-predominant, n = 17; diarrhoeapredominan t, n = 21) underwent 24-h ambulatory jejunal manometry before and afte r 12 week's treatment {cisapride, 5 mg three times daily (n = 19) or p lacebo (n = 19)}. Results: In diarrhoea-predominant patients significa nt differences in contraction characteristics were observed between th e cisapride and placebo groups. In cisapride-treated diarrhoea-predomi nant patients the mean contraction amplitude was higher (29.3 +/- 3.2 versus 24.9 +/- 2.6 mm Hg, cisapride versus placebo (P < 0.001); pretr eatment, 25.7 +/- 6.0 mm Hg), the mean contraction duration longer (3. 4 +/- 0.2 versus 3.0 +/- 0.2 sec, cisapride versus placebo (P < 0.001) ; pretreatment, 3.1 +/- 0.5 sec), and the mean contraction frequency l ower (2.0 +/- 0.2 versus 2.5 +/- 0.4 cont./min, cisapride versus place bo (P < 0.001); pretreatment, 2.5 +/- 1.1 cont./min) than patients tre ated with placebo. No significant differences in jejunal motility were found in the constipation predominant IBS group. Symptoms were assess ed by using a visual analogue scale before and after treatment. Sympto m scores relating to the severity of constipation were lower in cisapr ide-treated constipation-predominant IBS patients {score, 54 +/- 5 ver sus 67 +/- 14 mm, cisapride versus placebo (P < 0.05); pretreatment, 6 2 +/- 19 mm}. Diarrhoea-predominant IBS patients had a higher pain sco re after cisapride therapy {score, 55 +/- 15 versus 34 +/- 12 mm, cisa pride versus placebo (P < 0.05); pretreatment, 67 +/- 19 mm. Conclusio n: Cisapride affects jejunal contraction characteristics and some symp toms in IBS.