Thomas Eberl

The effect of cisapride on dysmotility-like functional dyspepsia: reduction of the fasting and postprandial area, but not of the postprandial antral expansion.

Objective To test the effect of cisapride on symptom score and on fasting and postprandial antral area in patients with dysmotility-like functional dyspepsia compared with controls. Methods Nineteen consecutive patients with dysmotility-like functional dyspepsia (13 females, six males, aged 18–79 y) and 12 control subjects (six females, six males, aged 19–68 y) were investigated. A symptom score including six upper digestive symptoms rated from 0 to 3 was applied. The patients received in a randomized order cisapride 10 mg t.i.d. (n = 10), or placebo (n = 9) for 3 days. The controls also received cisapride (n = 6) or placebo (n = 6) in the same way. The antral area in fasting condition and immediately after a semiliquid test meal (250 ml, 342 kcal) was assessed by real-time ultrasonography in front of the aorta and mesenteric vein. The measurements were carried out before starting and after finishing the trials with cisapride and placebo. Results The symptom score (mean ± SD) was 7.1 ± 2.4 in dysmotility-like functional dyspepsia vs 0.5 ± 0.2 in controls (P < 0.0001). The fasting antral area was 4.5 ± 0.9 cm2 in dysmotility-like functional dyspepsia vs 2.2 ± 0.2 cm2 in controls (P < 0.0001). Postprandial antral area was also larger in dysmotility-like dyspepsia than in controls (6.2 ± 1.0 vs 3.0 ± 0.3 cm2, P = 0.0001). Symptom score correlated with fasting antral area in dysmotility-like functional dyspepsia (r = 0.38, P = 0.05). Cisapride decreased the symptom score to 4.5 ± 2.5 (P= 0.0009) and placebo to 5.3 ± 2.4 (P=0.02). Cisapride significantly reduced the fasting antral area and the postprandial antral area in the dyspeptic group, but not in the control group. Postprandial antral expansion was not influenced by cisapride. Placebo did not change the sonographic parameters in both groups. Conclusions In dysmotility-like functional dyspepsia, fasting and postprandial antral areas are wider than in controls. Despite a good placebo response, cisapride is effective in improving the symptoms in dysmotility-like functional dyspepsia, associated with the reduction of fasting and postprandial antral areas.

Postprandial gastric relaxation in achalasia

Background In achalasia the incidence of autonomie neuropathy is increased, indicating that achalasia is not a disease of the oesophagus only. Little information is available concerning the function of the stomach in achalasia. We compared the postprandial gastric fundus relaxation in patients with achalasia to that of healthy controls. Methods In six patients with achalasia and six healthy controls postprandial fundus relaxation after a liquid test meal (500 ml, 500 kcal) was studied using an intragastric bag connected to an electronic barostat. The postprandia gastric relaxation was measured as an increase of intragastric bag volume; bag pressure was set at a constant level of 1 mmHg above the intra-abdominal pressure. All data are given as means ± SEM, and the Mann-Whitney test was used for statistical analysis. Results The intragastric volume before ingestion of the test meal was not different between groups. The maximum relaxation in patients with achalasia was significantly lower than in controls (132 ± 46 ml vs 238 ± 70 ml, P < 0.02). Postprandial relaxation was diminished and shortened in patients with achalasia as compared with controls. Similarly, the area under the volume curve was significantly smaller in patients with achalasia than in controls (29.8 ± 28.9 ml/h vs 102.9 ± 58.4 ml/h, P < 0.03) consistent with a diminished postprandial relaxation. Conclusion Patients with achalasia show a decreased postprandial gastric relaxation compared with healthy controls. We hypothesize that the neural damage in achalasia is not restricted to the oesophagus, but also involves the proximal stomach.