Long-term treatment with cisapride and antibiotics in liver cirrhosis: Effect on small intestinal motility, bacterial overgrowth, and liver function

OBJECTIVES: Altered small-bowel motility, lengthening of the orocecal trans it time, and small-intestinal bacterial overgrowth have been described in p atients with liver cirrhosis. These changes might be related to the progres sive course and poor prognosis of the disease. We investigated the effect o f a long-term treatment with cisapride and an antibiotic regimen on small-i ntestinal motor activity, orocecal transit time, bacterial overgrowth, and some parameters of liver function. METHODS: Thirty-four patients with liver cirrhosis of different etiology en tered in the study. They were randomly allocated to receive cisapride (12), an alternating regimen of norfloxacin and neomycin (12), or placebo (10) d uring a period of 6 months. At entry and at 3 and 6 months, a stationary sm all-intestinal manometry was performed, and orocecal transit time and small -intestinal bacterial overgrowth were also investigated using the H-2 breat h test. Liver Function was estimated with clinical and laboratory measureme nts (Child-Pugh score). RESULTS: After 6 months, both cisapride and antibiotics significantly impro ved fasting cyclic activity, reduced the duration of orocecal transit time, and decreased small-intestinal bacterial overgrowth. Cisapride administrat ion was followed also by an increase in the amplitude of contractions. No s tatistically significant variations in these parameters were observed with placebo. An improvement of liver function was observed at 3 and 6 months wi th both cisapride and antibiotics. CONCLUSIONS: Long-term treatment with cisapride or antibiotics reversed alt ered small-intestinal motility and bacterial overgrowth in patients with li ver cirrhosis. These findings suggest a possible role for prokinetics and a ntibiotics as a modality of treatment in selected cases of decompensated ci rrhosis. (Am J Gastroenterol 2001;96:1251-1255. (C) 2001 by Am. Coll. of Ga stroenterology).