Cisapride or metoclopramide to accelerate small bowel transit during barium follow-through examination?

Background: Metoclopramide is commonly used to accelerate small bowel trans it during barium follow-through (BaFT) examinations, but its action is unpr edictable. Cisapride, commonly used to treat gastroesophageal reflux diseas e, also accelerates small bowel transit and may be a viable alternative. Th e two were compared in a prospective, randomized, blind study. Methods: Patients attending for BaFT were randomized to receive either 10 m g cisapride or 20 mg metoclopramide orally 1 h before the barium suspension . BaFT was performed by using a standard technique, and small bowel transit and study quality were compared. Patients also noted any side effects expe rienced. Results: Of 45 patients recruited, 27 received cisapride and 18 metoclopram ide. Median transit time for the cisapride group was 30 min (range = 10-130 min) versus 67.5 min (range = 30-290 min) for the metoclopramide group (p = 0.019). Study quality was comparable. However, nine patients (33%) receiv ing cisapride experienced nausea versus only one subject (6%) receiving met oclopramide (p = 0.034). Conclusions: This study suggests that cisapride is a more effective prokine tic agent than metoclopramide, but this benefit is offset by a higher incid ence of side effects.