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Efficacy of Cisapride in Patients with Functional Dyspepsia Resistant to Dopamine Antagonists.

Sang In LEE ; Won Tae SEO ; In Suh PARK ; Yong Chan LEE ; Dong Gi LEE ; Kwang Jae LEE ; Do Young KIM ; Yong Woon SHIN ; Young Soo KIM ; Pum Soo KIM ; Dong Kee KIM

Korean Journal of Gastrointestinal Motility.2000;6(2):222-230.

BACKGROUND/AIMS: Prokinetics are commonly used for the treatment of functional dyspesia, but their methods of action are different. First, we compared the efficacy and safety of the dopamine receptor antagonists, which were domperidone maleate and levosulpiride, in a 2 week treatment in functional dyspepsia, then investigated the efficacy and safety of cisapride tartrate in a 2 week treatment in those who were resistant to domperidone maleate or levosulpiride. METHODS: One hundred Forty-nine patients, who were diagnosed with functional dyspepsia, were selected. The subjects were randomly divided into two groups, domperidone maleate (75) and levosupiride (74). Daily they took 30mg of domperidone maleate (DOM) or 75mg of levosulpiride (LEV) for 2 weeks. Then the subjects who didn't respond to these treatments took 30mg of cisapride tartrate for the following 2 weeks. RESULTS: At week 0, the total symptom scores of the DOM group and LEV group were 8.01+/-2.57 and 8.14+/-2.65 respectively, which were not statistically different. At week 2, the total symptom scores of the DOM and LEV groups were significantly reduced to 4.28+/-3.30 and 4.85+/-3.53(p=0.0001). The efficacy rates of the DOM and LEV groups at week 2 were 50.8% vs. 44.1%. The rate of adverse events in the LEV groups was much higher than in the DOM group(17.7% vs. 8.0%). In addition the rate of change from normal to abnomal in prolactin level was markedly higher in the LEV than that of the DOM group(80.0% vs. 8.3%). After 2 weeks of treatment with cisapride tartrate, the total symptom score was significantly reduced to 3.77+/-2.49(p=0.0001), and the efficacy rate was 75.0%. The satisfaction of the resistant subjects in efficacy of cisapride compared with the previous treatment was 73.3%. The rate of adverse events of cisapride tartrate was 5.0%. CONCLUSIONS: Considering efficacy and safety of domperidone maleate and levosulpiride, domperidone maleate was the safer drug for the treatment of functional dyspepsia, and cisapride tartrate can be a useful drug in those patients who are resistant to dopamine antagonists like domperidone maleate and levosulpiride.
2,5-Dimethoxy-4-Methylamphetamine ; Cisapride* ; Domperidone ; Dopamine Antagonists* ; Dopamine* ; Dyspepsia* ; Gastroesophageal Reflux ; Humans ; Prolactin

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The Role of Autonomic Dysfunction in Patients with Functional Dyspepsia.

Dong Il PARK ; Poong Lyul RHEE ; Yong Wook LEE ; Jee Eun KIM ; Jae Geun HYUN ; Chang Sup KIM ; Jae Kwon JANG ; Sang Goon SHIM ; In Kyung SUNG ; Young Ho KIM ; Hee Jung SON ; Jae Jun KIM ; Seung Woon PAIK ; Jong Chul RHEE ; Kyoo Wan CHOI

Korean Journal of Gastrointestinal Motility.2000;6(2):214-221.

BACKGROUND/AIMS: The role of autonomic dysfunction in patients with functional dyspepsia has not been completely understood. The purposes of our study are (1) to prospectively assess the abnormalities of the autonomic function in patients with functional dyspepsia and (2) to assess whether the presence of autonomic dysfunction in patients with functional dyspepsia correlates with the presence of visceral hypersensitivity or with the severity of dyspeptic symptoms. METHODS: Twenty eight patients with functional dyspepsia (4 men and 24 women; age range, 29-57) and 14 healthy volunteers without gastrointestinal symptoms (6 men and 8 women; age range, 23-61) were included in this study. All patients and controls were submitted to a battery of five standard cardiovascular autonomic reflex tests and gastric barostat tests. A modified version of the Glasgow Dyspeptic questionnaire was used in this study. RESULTS: (1) Autonomic function tests showed that both sympathetic and parasympathetic scores of dyspeptic patients were significantly higher than those of the control group. (2) Visceral hypersensitivity could be confirmed in some of our dyspeptic patients in response to proximal gastric distension, demonstrating lower pain threshold in this group. (3) We could not find significant association between the presence of autonomic dysfunction and the presence of visceral hypersensitivity or severity of dyspeptic symptoms in patients with functional dyspepsia. CONCLUSION: Autonomic dysfunction was more prevalent in dyspeptic patients than in the control group. However, it did not correlate with the presence of visceral hypersensitivity or severity of dyspeptic symptoms. It is suggested that a defect in the spinal region or at the CNS level may be a major mechanism of visceral hypersensitivity in functional dyspepsia.
Dyspepsia* ; Female ; Healthy Volunteers ; Humans ; Hypersensitivity ; Male ; Pain Threshold ; Prospective Studies ; Reflex ; Surveys and Questionnaires

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The Effects of Ranitidine (300mg) and Omeprazole (10, 20mg) on Gastroesophageal Reflux and Intragastric pH in Healthy Subjects.

Young Sun KIM ; Chi Wook SONG ; Yoon Hong KIM ; Hye Rang KIM ; Yun Bae KIM ; Byung Won HUR ; Jung Whan LEE ; Yoon Tae JEEN ; Chang Duck KIM ; Ho Sang RYU ; Jin Hai HYUN

Korean Journal of Gastrointestinal Motility.2000;6(2):206-213.

BACKGROUND/AIMS: This study was done to compare the effects of Omeprazole (OMD) 10 or 20 mg with Ranitidine(RAN) 300 mg on intragastric acidity and gastroesophageal reflux in healthy subjects. METHODS: Ten healthy male volunteers were studied after administrations of 5 days dosing with either RAN 300 mg, OMD 10 mg or 20 mg, once each morning. On the 5(th) day, intragastric pH and lower esophageal pH were measured by a dual channel antimony pH catheter for 10 hours. RESULTS: Gastroesophageal reflux was reduced after administrations of RAN 300 mg, OMD 10 mg or 20 mg (p < 0.05) and there was no significant difference among the three drugs (p > 0.05). The gastric holding time of pH > 4 was significantly prolonged over fasting and postprandial periods after RAN 300 mg, OMD 10 mg or 20 mg administrations (p < 0.05). OMD 20 mg showed the most potent effect on gastric acid suppression (p < 0.05), but there was no significant difference between RAN 300 mg and OMD 10 mg (p > 0.05). OMD administrations (10 mg or 20 mg) exhibited a more potent effect on gastric acid suppression during the postprandial period than RAN 300 mg (p < 0.05). CONCLUSIONS: OMD 10 mg was as potent as RAN 300 mg on inhibition of gastric acid, but less potent than OMD 20 mg. There was no difference among the three drugs in regard to gastroesophageal reflux in healthy subjects.
Antimony ; Catheters ; Fasting ; Gastric Acid ; Gastroesophageal Reflux* ; Humans ; Hydrogen-Ion Concentration* ; Male ; Omeprazole* ; Postprandial Period ; Ranitidine* ; Volunteers

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The Significance of Gastroesophageal Reflux Disease (GERD) Symptoms in Patients with Reflux Esophagitis.

Chan Hee HAN ; Joon Seong LEE ; Hee Hyuk LIM ; Young Soo OH ; Young Keun YOON ; Sang Gyune KIM ; Myung Soo KIM ; Eun Sang RYOO ; Dong Jin YOUN ; In Seop JUNG ; Bong Min KO ; Chang Bum YOO ; Young Deok CHO ; Joo Young CHO ; Moon Sung LEE ; Chan Sup SHIM

Korean Journal of Gastrointestinal Motility.2000;6(2):196-205.

BACKGROUND/AIMS: The relationship between the symptoms and severity of GERD may be difficult to prove. The intensity and frequency of reflux induced symptoms are poor predictors of the presence or severity of an endoscopic mucosal break. The aim of this study was to determine which factors can be predicted by the presence of GERD symptoms among esophageal sensitivity to acid, abnormal acid reflux, and severity of esophagitis in pateints with reflux esophagitis. METHODS: Fourty-four patients who were diagnosed with reflux esophagitis by an endoscopy at a tertiary medical facility, were given a validated questionnaire, and underwent an acid perfusion test, 24 hr ambulatory esophageal pH monitoring, and esophageal manometry. These patients were divided into a symptomatic group and asymptomatic group according to the questionaire. Comparisons between the two groups for each factor were analyzed by Chi-square. RESULT: Of 44 patients, 26 had symptoms and 18 did not. The positive and equivocal rates of the acid perfusion test were not different between the symptomatic and asymptomatic groups (47% vs. 39%). The abnormal reflux rate (DeMeester score > 14.72) from pH monitoring was significantly higher in the symptomatic group than in the asymptomatic group (65% vs. 28%, p < 0.05). The severity of esophagitis, presence of a hiatal hernia, and abnormal esophageal manometric findings were not different between the two groups. CONCLUSION: It would be impossible to predict esophageal sensitivity to acid, severity of the esophagitis grade, and the presence of hiatal hernia with GERD symptoms, but it could be possible to predict abnormal gastroesophageal reflux.
Endoscopy ; Esophageal pH Monitoring ; Esophagitis ; Esophagitis, Peptic* ; Gastroesophageal Reflux* ; Hernia, Hiatal ; Humans ; Hydrogen-Ion Concentration ; Manometry ; Perfusion ; Surveys and Questionnaires

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The Incidence of Gastroesophageal Reflux Disease and the Effect of Cisapride in Patients with Epigastric Soreness.

Yun Bae KIM ; Chi Wook SONG ; Hye Rang KIM ; Sang Woo LEE ; Young Tae BAK ; Jin Hai HYUN ; Jeong Seop MOON ; Hyun Chul PARK

Korean Journal of Gastrointestinal Motility.2000;6(2):188-195.

BACKROUND/AIMS: It has been thought that in many of those who complain of "epigastric soreness," their symptom is actually "heartburn" secondary to gastroesophageal reflux disease (GERD). This study was undertaken to determine the incidence of GERD in patients who complain of epigastric soreness and to evaluate the effect of cisapride tartrate on their symptoms. METHODS: A total 107 patients who visited tertiary referral hospitals and complained of epigastric soreness were enrolled. We evaluated their symptoms and performed esophagogastroduodenoscopies (EGD). In 53 of the 107 patients who showed a normal EGD, gastroesophageal reflux studies (24 hour ambulatory pH monitoring, Bernstein test, modified Bernstein test) were performed. RESULTS: Of the 107 patients, 36 had organic gastroduodenal diseases, 18 had reflux esophagitis, and 53 showed a normal EGD finding. Of these 53 patients, the gastroesophageal reflux studies were normal in 23 patients and abnormal in 30. Forty eight (44.9%) of 107 patients showed reflux-associated epigastric soreness. There was no difference in demographic characteristics among reflux-associated, gastroduodenal, and functional epigastric soreness groups. Among clinical characteristics of the 3 groups, the only difference found was the time of the symptoms during a day. In the reflux-associated epigastric soreness group, the symptoms were more severe during daytime. After cisapride tartrate administration for 4 weeks, symptom scores of reflux-associated and functional epigastric soreness groups improved from 9.2+/-3.9 and 10.4+/-3.9 to 4.0+/-3.8 and 3.8+/-2.2, respectively. CONCLUSIONS: We found a great number of patients having GERD among those complaining of "epigastric soreness." Cisapride tartrate was effective in relieving epigastric soreness in reflux-associated and functional epigastric soreness groups.
Cisapride* ; Endoscopy, Digestive System ; Esophagitis, Peptic ; Gastroesophageal Reflux* ; Humans ; Hydrogen-Ion Concentration ; Incidence* ; Tertiary Care Centers

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Characteristics of Transient Lower Esophageal Sphincter Relaxation in Healthy Korean Adults.

Byung Won HUR ; Chi Wook SONG ; Hye Rang KIM ; Yun Bae KIM ; Chang Don KANG ; Jung Whan LEE ; Yoon Tae JEEN ; Hoon Jai CHUN ; Soon Ho UM ; Sang Woo LEE ; Jai Hyun CHOI ; Chang Duck KIM ; Ho Sang RYU ; Jin Hai HYUN

Korean Journal of Gastrointestinal Motility.2000;6(2):180-187.

BACKGROUND/AIMS: Transient lower esophageal sphincter relaxation (tLESR) is the main cause of gastroesophageal reflux (GER) in both healthy subjects and patients with GER disease. Unfortunately, we have no data on tLESR and its relationship with GER in Korea. Therefore, this study was performed to evaluate the characteristics of tLESR in Korean subjects and the mechanisms of GER after Korean meals. METHODS: Eight healthy volunteers (8 men, 23 to 25 yrs) received a Korean meal (laver-rolled rice, fried egg, sweet rice juice, 640 Kcal). A mylohyoid electromyogram, LES pressure using a Dent sleeve and esophageal pH were simultaneously recorded for 1 hour while fasting and 3 hours after the meal. We compared the manometric profile of swallow-induced LES relaxation (sLESR) with the manometric profile of tLESR and evaluated the frequency of tLESR and reflux episodes, and their relationship. RESULTS: Compared with sLESR, tLESR showed longer time onset to completion, slower relaxation rate, longer duration of relaxation, and a lower nadir pressure. Incidence of tLESR increased after the meal, which was mostly accompanied by GER. Also, the frequency of GER increased after the meal, which mostly occurred during tLESR. CONCLUSIONS: Our results suggest that tLESR is a main cause of GER in healthy Korean adults, which is a similar result to studies of Westerners.
Adult* ; Esophageal Sphincter, Lower* ; Fasting ; Gastroesophageal Reflux ; Healthy Volunteers ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Korea ; Male ; Meals ; Ovum ; Relaxation*

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The Pattern of Gastroesophageal Reflux in Patients with Gastroesophageal Reflux Disease.

Theresa JANG ; Baek Sun KIM ; Sun Myung KIM ; Kyo Young CHOO ; Jung Hwan OH ; Young Geun HYUN ; Soo Heon PARK ; Myung Gyu CHOI ; Jun Yeol HAN ; Jae Kwang KIM ; In Sik CHUNG ; Kyu Won CHUNG ; Hee Sik SUN

Korean Journal of Gastrointestinal Motility.2000;6(2):173-179.

BACKGROUND/AIMS: Generally, it is recommended for patients with gastroesophageal reflux disease to sleep with the head of the bed elevated; however, many patients in Korea do not have heartburn symptoms during the night. METHODS: We investigated the pattern of acid reflux in patients who were diagnosed as having definite pathological acid reflux on 24-hour pH monitoring. RESULTS: One hundred patients were categorized into 3 groups; upright refluxer (68%), supine refluxer (2%), or combined refluxer (30%). Acid reflux was rare in supine positions but instead, usually occurred in upright positions. Acid reflux was found to occur most commonly after meals. The reflux symptoms occurred during pH monitoring with the average frequency of 5.5 times (total of 254 times) in 46 patients. The acid related symptoms were more common in the upright period and postprandially than the supine period. The presence of an esophagitis, an esophageal motility disorder, or the LES pressure did not make a significant difference between upright refluxer and supine refluxer. CONCLUSIONS: Gastroesophageal reflux was found to be rare in supine positions but usually occurred in upright positions. Gastroesophageal reflux occurred most commonly after meals, and was frequently associated with reflux symptoms.
Esophageal Motility Disorders ; Esophagitis ; Gastroesophageal Reflux* ; Head ; Heartburn ; Humans ; Hydrogen-Ion Concentration ; Korea ; Meals ; Supine Position

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The age of H2 antagonists for reflux has passed Consultant Physician and Gastroenterologist.

Robert P WALT

Korean Journal of Gastrointestinal Motility.2001;7(1):73-74.

Consultants* ; Humans

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A Multicenter Clinical Trial of Cisapride Tartrate in Diabetic Patients with Dysmotility Like Dyspeptic Symptoms.

Sun Myung KIM ; Kyo Young CHOO ; Myung Gyu CHOI ; Jin Il KIM ; Choon Sang BHANG ; Sok Won HAN ; Byung Wook KIM ; Hwang CHOI ; Sung Soo KIM ; Dong Soo LEE ; Kyu Yong CHOI ; Moo Il KANG ; In Sik CHUNG

Korean Journal of Gastrointestinal Motility.2001;7(1):56-64.

BACKGROUND/AIMS: We evaluated the effects of cisapride tartrate on gastrointestinal symptoms and gastric emptying times in diabetic patients with dysmotility like dyspeptic symptoms. METHODS: Cisapride was administered before each meal in 61 patients for 4 weeks. The intensity of gastrointestinal symptoms before and after cisapride administration was scored from 0 to 4, in the order of increasing severity of symptoms. In addition, a gastric emptying test was performed. RESULTS: A significant reduction in the total intensity score of symptoms was observed during the first two weeks, from 8.5+/-2.1 to 4.0+/-3.0 (p < 0.05), and a further reduction was noted during the next two weeks, to 2.8+/-2.8 (p < 0.05). Good to excellent improvement was obtained in 70.4% of the patients, but the improvement in symptoms was not related to age, duration of diabetes, glucose, Hb A1c, neuropathy, or retinopathy. Treatment with cisapride induced a significant regression of symptoms and a significant improvement of delayed gastric emptying from 104.0+/-31.7 minutes to 79.5+/-17.1 (p < 0.05). However, there was a lack of association between the changes in gastric emptying times and improvements in symptoms(r(2)=0.00186). Only 3 patients complained of loose stool, nausea, or dizziness. CONCLUSIONS: Cisapride was effective in improving dysmotility like dyspeptic symptoms in diabetic patients without serious side effects.
Cisapride* ; Dizziness ; Dyspepsia ; Gastric Emptying ; Glucose ; Hemoglobin A, Glycosylated ; Humans ; Meals ; Nausea

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Electrogastrography in Uremic Patients on Maintenance Hemodialysis with Dyspepsia.

Jeong Hoon JI ; Tae Won LEE ; Young Sun PARK ; Ki Won CHOI ; Hye Young KIM ; Sun Mi PARK ; Hoe Bok CHAI ; Jae Ho UM ; Sei Jin YOUN

Korean Journal of Gastrointestinal Motility.2001;7(1):47-55.

BACKGROUND/AIMS: The changes in an Electrogastrography (EGG) in uremic patients on maintenance hemodialysis with dyspeptic complaints are not well known. The aim of this study was to investigate the EGG findings in uremic patients with dyspeptic complaints and note the difference of EGG findings between uremic patients with dyspeptic complaints and patients with functional dyspepsia. METHODS: Fifty two subjects were enrolled. They were assigned to: group I, healthy volunteers without dyspeptic complaints (n=15); group II, patients with dysmotility-like dyspepsia (n=22); or group III, uremic patients undergoing hemodialysis with dysmotility-like dyspepsia (n=15). The data was compared among groups. RESULTS: There was no difference in the percentage of normal slow wave frequency, and fed to fasting power ratio among the groups. However, frequencies of abnormal EGG findings were 4 (27%) in group I, 10 (40%) group II and 9 (60%) in group III. Therefore the frequency was marginally different among group I, group II or group III (p=0.06). CONCLUSIONS: Impaired gastric myoelectric activity was more frequently observed in uremic patients or patients with dysmotility-like dyspepsia than normal controls. However frequencies of abnormal EGG findings between uremic patients and patients with dysmotility-like dyspepsia were not significantly different.
Dyspepsia* ; Fasting ; Healthy Volunteers ; Humans ; Kidney Failure, Chronic ; Ovum ; Renal Dialysis*

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