The effect of 12 weeks of cisapride on esophageal and gastric function in patients with gastroesophageal reflux disease

Cisapride is gaining acceptance as a useful agent for the treatment of gastroesophageal reflux disease. It has been studied extensively only in short-term studies, where it has been demonstrated to enhance both esophageal and gastric function. This study examined the effect of 12 weeks' treatment with cisapride in patients with gastroesophageal reflux disease. Esophageal manometry, 24-h pH monitoring, endoscopy and radionuclide gastric emptying studies were performed before and after treatment. Nineteen patients were enrolled in the treatment phase and 13 patients completed the study. Overall symptomatic improvement was achieved in ten patients. Improvement was also demonstrated in endoscopic appearances of esophagitis, and lower esophageal sphincter pressure. Acid exposure measured by 24-h pH monitoring only improved in a subgroup with reduced resting lower esophageal sphincter pressure. Gastric emptying remained unchanged following 12 weeks' treatment with cisapride. Overall improvement was unrelated to pretreatment gastric emptying or lower esophageal sphincter pressure status. Whilst numbers are small, this study supports the postulate that cisapride improves and heals esophagitis due to its effect on the lower esophageal sphincter. It has failed to demonstrate a sustained effect on gastric emptying. By examining pretreatment lower esophageal sphincter pressure or gastric emptying status, no subgroup could be identified to be more likely to respond to treatment.