The effect of different dosage schedules of cisapride on gastric emptying in idiopathic gastroparesis

Summary The aim of this study was to determine the optimal dosage regimen of cisapride for the treatment of idiopathic gastroparesis.We studied 17 patients with documented idiopathic gastroparesis in a three-way, cross-over, double-blind study with three 4-day treatment periods separated by at least 3 days without treatment. In each period, the patients were preloaded with cisapride (10 mg tid) for three days. On the fourth day (the test day) they took either 10 mg or 20 mg before breakfast and placebo before lunch (1×10 mg), (1×20 mg), or 10 mg before breakfast and 10 mg before lunch (2×10 mg). The medications were taken 30 min before meals. Gastric emptying of solids (^99mTc-sulphur colloid) was measured at lunch time under basal conditions and during each treatment period. Plasma concentrations of cisapride were determined before the breakfast dose, before the lunch dose, and at 1, 2, 3, 4 and 5 h after.The greatest acceleration in gastric emptying occurred with the 2×10 mg regimen. Although the single morning dose of 20 mg also significantly accelerated gastric emptying (P=0.05), the reduction was not as substantial.Plasma concentrations of cisapride were significantly higher after 2×10 mg than after 1×20 mg or 1×10 mg. There was a significant relation between cisapride plasma concentrations and changes in gastric emptying. Peak concentrations of cisapride greater than 60 ng·ml^–1 were invariably associated with acceleration of gastric emptying.We conclude that cisapride 10 mg tid before meals is the optimal dose for the treatment of idiopathic gastroparesis.     

The effect of oxytocin on basal and pethidine-induced delayed gastric emptying.

1. Continuous infusion of oxytocin (0.33 u min-1) accelerated gastric emptying of semisolid TC-99m labelled Chelex-100 resin/oatmeal in 10 healthy volunteers under basal conditions. 2. Administration of oxytocin did not change the pattern of gastric emptying delayed by pethidine. 3. The emptying pattern of semisolid has confirmed the existence of a lag phase.     

Comparison of the effect of cisapride and metoclopramide on morphine-induced delay in gastric emptying.

1. The effects of metoclopramide or cisapride on morphine-induced delay in gastric emptying in patients before surgery were compared. 2. Forty patients were allocated randomly to receive one of four premedications i.m.: placebo only, morphine 10 mg alone, morphine 10 mg with metoclopramide 10 mg and morphine 10 mg with cisapride 10 mg. Gastric emptying after each premedication was assessed indirectly from the rate of absorption of oral paracetamol. 3. Cisapride 10 mg reversed the delay in gastric emptying due to morphine. Its effects were significantly greater than those of metoclopramide 10 mg.     

胰头十二指肠切除术后胃排空延迟及严重程度的 影响因素分析

目的探讨胰头十二指肠切除术后胃排空延迟及严重程度的发生情况及影响因素。方法选择 2013年 1月至 2017年 10月在平煤神马医疗集团总医院行胰头十二指肠切除术病人 156例的临床资料进行回顾性分析。分析影响胃排空延迟的影响因素、影响胃排空延迟不同严重程度的相关因素。结果多因素分析结果显示胃空肠吻合方式 Roux?en?Y法、管型吻合器直径 28 mm是保护因素,保留幽门、术中出血量 ≥1 000 mL、术后白蛋白水平＜ 30 g/L,术后腹部并发症是胃排空延迟的高危因素( P＜0.05);年龄 ≥65岁、术后腹部并发症是影响胃排空延迟严重程度的独立危险因素( P＜0.05)。结论 Roux?en?Y法胃空肠吻合、管型吻合器直径 28 mm可降低胃排空延迟的风险,保留幽门、术中出血量 ≥1 000 mL、术后白蛋白水平＜ 30 g/L,术后腹部并发症增加胃排空延迟的风险;年龄≥65岁、术后腹部并发症是影响胃空肠排空延迟严重程度的独立危险因素。     

Fat preload delays gastric emptying: reversal by cisapride.

1. Meals empty more slowly when they contain fat. 2. This study investigated whether an intragastric fat preload in comparison with a water preload affected gastric emptying of a semisolid meal and antral motor activity, and whether cisapride reversed such effects. 3. Twelve healthy subjects were studied under three conditions each: (A), preload of 50 ml water orally; (B) and (C), preload of 50 ml cream (20 g fat). After preloads, subjects reclined right sided for 20 min. Thereafter, placebo in conditions (A) and (B) and 10 mg cisapride in (C) were administered i.v. in a random double-blind fashion and subjects ingested a semisolid radiolabelled 1150 kJ meal. Gastric emptying and antral motor activity were recorded scintigraphically for 50 min using a dual-headed gamma camera. 4. Gastric emptying was significantly slower (P less than 0.005) after fat preload and placebo than after water preload and placebo. Cisapride administered after fat preload abolished the delaying effect of the fat preload (P less than 0.001). 5. Antral contraction amplitudes after fat preload and placebo were higher (P less than 0.01) than after water preload and placebo as well as fat preload and cisapride at the start of recording and decreased slightly thereafter, whereas slight increases occurred in the other conditions. Frequency and propagation velocity of contractions were not differently affected. 6 Gastric emptying is delayed after prior fat ingestion and this effect is abolished by cisapride.     

The action of cisapride on gastric emptying and the pharmacodynamics and pharmacokinetics of oral diazepam

Summary The effects of the benzamide cisapride (C) (8 mg) i.v. have been compared to placebo (P) in a double blind randomised study. The effects on gastric emptying, the absorption and effects of oral diazepam, and BP and pulse were observed.Cisapride increased the rate of gastric emptying of 500 ml liquid containing diazepam 10 mg (t_1/2 C: 7.4 min, P: 14.9 min). The initial rate of absorption of diazepam contained in the drink was increased by C (AUC 0–1 h C: 328 µg h 1^–1, P: 253 µg h 1^–1, but there was no change in overall bioavailability. This change in diazepam kinetics was associated with a significantly greater impairment in reaction time in the first 45 min after drinking but not in self rated sedation. Cisapride produced a significant tachycardia (e.g. after 10 min C: 82 beats/min, P: 69 beats/min) which probably reflects a peripheral vasodilator action. Cisapride may therefore alter the pharmacokinetics and dynamics of concurrently administered drugs.     

Impact of gastric emptying on the pharmacokinetics of ethanol as influenced by cisapride

AIMS: To examine the influence of cisapride on the pharmacokinetics of ethanol and the impact of gastric emptying monitored by the paracetamol absorption test. METHODS: Ten healthy male volunteers took part in a cross-over design experiment. They drank a moderate dose of ethanol 0.30 g kg-1 body weight exactly 1 h after eating breakfast either without any prior drug treatment or after taking cisapride (10 mg three times daily) for 4 consecutive days. In a separate study, the same dose of ethanol was ingested on an empty stomach (overnight fast). Paracetamol (1.5 g) was administered before consumption of ethanol to monitor gastric emptying. Venous blood was obtained at 5-10 min intervals for determination of ethanol by headspace gas chromatography and paracetamol was analysed in serum by high performance liquid chromatography (h.p.l.c.). Results The maximum blood-ethanol concentration (Cmax ) increased from 3.8+/-1.7 to 5.6+/-2.3 mmol l-1 (+/-s.d.) after treatment with cisapride (95% confidence interval CI on mean difference 0.28-3.28 mmol l-1 ). The area under the blood-ethanol curve (AUC) increased from 6.3+/-3.5 to 7.9+/-2.6 mmol l-1 h after cisapride (95% CI -0. 74-3.9 mmol l-1 h). The mean blood ethanol curves in the cisapride and no-drug sessions converged at approximately 2 h after the start of drinking. Both Cmax and AUC were highest when the ethanol was ingested on an empty stomach (Cmax 9.5+/-1.7 mmol l-1 and AUC 14. 6+/-1.9 mmol l-1 h), compared with drinking 1 h after a meal and regardless of pretreatment with cisapride. CONCLUSIONS: A small but statistically significant increase in Cmax occurred after treatment with cisapride owing to faster gastric emptying rate as shown by the paracetamol absorption test. However, the rate of absorption of ethanol, as reflected in Cmax and AUC, was greatest after drinking the alcohol on an empty stomach. The cisapride-ethanol interaction probably lacks any clinical or forensic significance.     

Effect of cisapride on gastric emptying in diabetic patients without gastrointestinal symptoms.

The long-team effects of cisapride on gastric emptying and hormonal interaction in diabetic patients without gastrointestinal symptoms was evaluated. Gastric emptying was determined by the N-acetyl-p-amino-phenol (APAP) method before and after cisapride treatment. Gastric emptying improved significantly, from 5.95 to 8.04 micrograms/ml, after 6 weeks of treatment. Plasma concentrations of immunoreactive insulin (IRI), after 30 and 45 minutes in the gastric emptying test, increased significantly after treatment. It appeared that improvement of gastric emptying after loading with cisapride might be related to improved insulin secretion in diabetic patients without subjective symptoms of gastroparesis.     

胃大部切除术后残胃功能性排空障碍的护理观察

目的对胃大部切除术后残胃功能性排空障碍的护理效果进行分析探讨。方法随机抽取本院收治的胃大部切除术后发生残胃功能性排空障碍的临床患者86例,将其分成对照组和观察组,对照组给予常规药物治疗和护理,观察组在常规治疗与护理的基础上实施有针对性的综合护理干预措施,比较两者患者护理效果。结果经统计发现两组患者SAS与SDS评分均较护理前降低,且观察组下降幅度大于对照组,且差异具有统计学意义(P<0.05)。结论给予胃大部切除术后发生残胃功能性排空障碍的临床患者合理的综合护理干预措施能够有效提高护理效果,提高患者的转能动性,改善预后。     

胃癌术后残胃功能性排空障碍的治疗方法研究

胃癌术后残胃功能性排空障碍是医学界普遍存在的难题,临床分析和研究的工作依然任重道远。本资料首先简单介绍该并发症的概念和发病机制,然后分析该并发症的临床表现和处理原则,并详细介绍目前常用的治疗方法,最后做出总结性治疗及前景展望。     

食管癌术后胃排空障碍的分析

目的:探讨食管上中段癌切除食管胃颈部吻合术后胃排空障碍的原因。方法:对57例食管上、中段癌病人临床资料进行回顾性分析。结果:功能性胃排空障碍3例(5.26%),机械性胃排空障1例(1.75%)。结论:胃排空障碍多为功能性,少数为机械性,功能性胃排空障碍主要与迷走神经干的切断及胃解剖位置的变化有关,机械性胃排空障碍主要与手术操作有关。     

The effect of metoclopramide on neonatal gastric emptying.

1 The effect of metoclopramide on gastric emptying was studied on twenty-five occasions in fifteen low birth weight babies. 2 The serial test-meal technique was used. 3 The results indicate that metoclopramide does not promote gastric emptying in the newborn period.     

胃大部切除术后胃排空障碍的病因及诊治分析

目的:探讨胃大部切除术后胃排空障碍(FDGE)发生的病因、诊断方法及治疗手段。方法:对2007年5月—2011年5月因胃大部切除术后出现胃排空障碍的患者的临床资料进行回顾性分析。结果:观察期间行胃大部切除术的134例患者中,8例出现胃排空障碍,发生率为6%。术前流出道梗阻和胃肠手术吻合方式是诱发本病的危险因素。X线口服造影、胃镜是诊断FDGE的重要手段。8例经对症保守治疗13~35 d后均治愈。结论:胃大部切除术后功能性胃排空障碍在临床上的发生率并不少见,准确诊断及积极治疗十分重要。     

The effect of polycarbophil on the gastric emptying of pellets

The influence of the putative bioadhesive, polycarbophil, on the gastric emptying of a pellet formulation, has been investigated in three fasted subjects. The pellets were radiolabelled with technetium-99m. Gastric emptying was measured using the technique of gamma scintigraphy. The pellets emptied from the stomach rapidly and in an exponential manner. Polycarbophil did not retard the gastric emptying of the pellets.     

The effect of nicotine on the delay of gastric emptying

The effect of cigarette smoking and its active component, nicotine, on the gastric emptying of solid food was assessed in a randomized double-blind crossover design. Ten regular smokers were studied after a 6 h fast and least 18 h after their last cigarette. Subjects smoked a total of three high (1.91 mg) or low (0.17 mg) nicotine cigarettes, before and after a technetium-labelled solid meal and were scanned by gamma camera periodically over a 2-h period. All calculations of gastric emptying revealed a significant delay after smoking high versus low nicotine cigarettes in: mean per cent isotope remaining in the stomach at each measurement point from 90-120 min; amount of meal remaining in the stomach at 2 h; and mean time at which 50% of the meal had emptied (T1/2). Delay in gastric emptying was significantly correlated with increase in serum nicotine concentration on the high nicotine day.     

胃大部切除术后残胃功能性胃排空障碍的临床护理

目的探讨护理干预对胃大部切除术后残胃功能性排空患者抑郁及治疗依从性的影响。方法将26例胃大部切除术后胃功能性排空患者随机分为对照组和干预组,对照组采用常规治疗和护理,干预组在常规治疗和护理的基础上采用密切观察、心理干预、对症处理等综合干预方法。对两组患者治疗前后的SAS和SDS评分以及治疗依从性进行比较分析。结果两组患者干预后SAS和SDS评分均有所下降,且与对照组相比,干预组SAS和SDS评分明显降低,差异具有统计学意义（P〈0.05）。与此同时,干预组与对照组相比,完全依从的比率明显提高,差异具有统计学意义（P〈0.05）,而一般依从的比率和不能依从的比率差异不显著（P〉0.05）。结论全面系统的护理干预可以充分调动患者的主观能动性,使患者有充分的思想准备,调整心理状态,提高其对治疗的依从性及信心,从而有效地提高患者及其家庭的生活质量。     

胃术后功能性胃排空障碍临床分析

目的：探讨胃术后功能性胃排空障碍（FDGE）的病因、诊断和治疗。方法：回顾性分析我院26例FDGE的临床资料。结果：本组26例中有12例（46．1％）于治疗后7～14d内恢复胃动力,8例（30．8％）于15～21d内恢复胃动力,4例（15．4％）于22～28d内恢复胃动力,2例（7．7％）于29～32d内恢复胃动力。结论：FDGE的病因是多因素,消化道造影及胃镜检查是诊断FDGE方便、可靠的方法,采用综合性治疗措施可有效治愈FDGE。     

The effect of cold-restraint stress on gastric emptying in rats

The effects of drug treatment and of cold-restraint stress (a method used to produce experimental stomach ulcers) on gastric emptying of a resin (colestipol-phenol red complex) were investigated in rats. Gastric emptying was decreased by intraperitoneal treatment with atropine (0.3 mg/kg) or verapamil (4 mg/kg), and enhanced by bethanechol (1.2 mg/kg). Stress by restraint at 4 degrees C for 2 hr markedly reduced gastric emptying; the pattern of effects of drug pretreatment in these stressed rats was similar to that seen in their nonstressed controls. Further experiments, with stress for 3 hr, revealed that the gastric emptying rate was triphasic; increasing in the first hr, returning to normal and then slowing in the third hr of stress. Initial increase in emptying rate was probably due to predominant vagal overactivity. Hypothermia and possibly other factors induced by cold-restraint stress could have subsequently depressed gastric motility.     

Prokinetic effect of gut-oriented hypnosis on gastric emptying

BACKGROUND: No data are available on the effect of hypnosis on gastric emptying. AIM: To determine the effect of a hypnosis session on gastric emptying and dyspeptic symptoms. METHODS: We studied emptying by ultrasonography and epigastric sensations in 11 healthy subjects and in 15 patients affected by functional dyspepsia under three conditions according to a fixed schedule: (a) basal, (b) after cisapride and (c) during a 90 min hypnotic trance. Eight healthy subjects repeated an emptying study listening to relaxing music. Statistical analysis was performed using the Friedman test or RM-ANOVA. RESULTS: In dyspeptics, the postprandial increase in the antral area was significantly smaller during the hypnosis trance than under the basal and the cisapride conditions. For the patients gastric emptying was significantly shortened by cisapride, and even more by hypnosis (basal 274 +/- 16.8 min; cisapride 227 +/- 13.2; hypnosis 150 +/- 9.7) whereas for healthy subjects it was shortened only by hypnosis. The repeated study in healthy subjects listening to relaxing music showed no significant difference compared with the basal. Epigastric sensations were improved in dyspeptics by hypnosis, but not by cisapride. CONCLUSIONS: Gut-oriented hypnosis is effective in shortening gastric emptying both in dyspeptic and in healthy subjects.     

The effect of ondansetron on gastric emptying in the conscious rat

The 5-HT3 receptor antagonist ondansetron (GR38032F) enhanced the action of a protein-rich solution in delaying gastric emptying in the conscious gastric fistula rat, but had no effect on the emptying of isotonic or hypertonic saline, acid or FOY-305 which delays emptying by release of cholecystokinin (CCK). The specific CCK-A antagonist (L-364,718) increased gastric emptying of protein-rich meals. L364,718 also increased emptying in the presence of ondansetron. They indicate that protein-rich meals release both CCK and 5-hydroxytryptamine which act in different ways to control gastric motility.