Prokinetic medication following surgical treatment of GERD patients with impaired esophageal peristalsis: A randomized controlled trial (RCT)

Background: Long-standing gastroesophageal reflux disease (GERD) is frequen tly associated with impaired esophageal body motility. Partial posterior fu ndoplication improves esophageal peristalsis. The aim of this prospective r andomized study was to investigate whether administration of the prokinetic agent cisapride enhances this effect. Methods: Forty consecutive GERD patients with impaired esophageal peristals is entered the study and were randomized in two groups: group 1 with and gr oup 2 without postoperative treatment with cisapride (6 months, 20 mg twice daily). Four patients had to be excluded during the study. Esophageal moti lity was analyzed preoperatively and 6 months after surgery by measuring co ntraction amplitudes in the distal two thirds of the esophagus, frequency o f simultaneous and interrupted peristaltic waves and total number of defect ive propagations. Results: In both groups esophageal peristalsis was improved significantly f ollowing partial posterior fundoplication (p < 0.05; Wilcoxon Test). Howeve r, this eff ect was significantly more pronounced in patients receiving cis apride medication postoperatively (p < 0.05; Mann-Whitney U test). Lower es ophageal sphincter pressure, intraabdominal sphincter length and the DeMees ter reflux score were normalized in both groups following antireflux surger y. Conclusions: Partial posterior fundoplication combined with postoperative c isapride medication seems to be the therapy of choice in GERD patients with impaired esophageal body motility.