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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The effects of some drugs generally used in premedication for and induction of anaesthesia on the lower oesophageal sphincter (LOS) pressure were investigated in 30 dogs, using the modern oesophageal manometric technique. In thiopental-induced anaesthesia, a distinct pressure gradient was noted between the LOS and gastric pressure. Atropine eliminated this pressure gradient almost completely. Metoclopramide increased the LOS pressure significantly, and subsequent atropine administration was unable to bring it down. Metoclopramide administered after atropine was unable to elevate the LOS pressure reduced by atropine. Succinylcholine had no observable lasting effect on the LOS pressure. The present findings seem to indicate that of the drugs generally used in premedication for and induction of anaesthesia, atropine significantly reduces the LOS competence, thereby creating favourable conditions for gastro-oesophageal reflux (GOR) and consequent postoperative pulmonary complications. Use of metoclopramide in premedication for or induction of anaesthesia to eliminate the depressant effect of atropine on the LOS pressure appears to be indicated.
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PMID:Anaesthesia induction and lower oesophageal sphincter pressure. 63 1

The effects of oral metoclopramide, 10 and 20 mg, bethanechol, 25 mg, and placebo on lower esophageal sphincter pressure (LESP) were studied in 15 men with symptoms of gastroesophageal reflux and basal LESP less than 11 mm Hg. Each drug produced a significant increase in LESP when compared to placebo. Metoclopramide, 20 mg, produced a greater increase than either metoclopramide, 10 mg, or bethanechol, 25 mg. Serum gastrin concentrations were not altered by any of the drugs. Side effects were unremarkable. The LESP increasing effect of metoclopramide might be useful in treatment of gastro-esophageal reflux.
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PMID:Comparative effects of metoclopramide and bethanechol on lower esophageal sphincter pressure in reflux patients. 109 85

A dopamine receptor antagonist, metoclopramide has unique properties of increasing lower esophageal sphincter pressure and increasing the rate of gastric emptying. These gastrointestinal motility actions are useful in the treatment of diabetic gastroparesis and severe gastroesophageal reflux and in postoperative situations involving visceral atony. Metoclopramide is a useful adjunctive drug for intestinal intubation and radiologic examination. It has also been used intravenously to control the nausea and vomiting of intensive cancer chemotherapy, such as with cisplatin. Metoclopramide is a powerful antiemetic because of its combined actions on the chemoreceptor trigger zone and intestinal motility. This agent is generally not intended for long-term use. The oral preparations are recommended for four to 12 weeks of therapy. Use of parenteral metoclopramide should be limited to one or two days. The most common adverse reactions are restlessness, drowsiness, fatigue and lassitude. Extrapyramidal symptoms occur rarely and only with high dosage or prolonged use.
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PMID:Metoclopramide: a dopamine receptor antagonist. 240 79

Among 4,411 children hospitalized from May 1985 through April 1987, 100 infants (mean age three months) had exhibited an apparently life-threatening event. Management included careful history taking by interviewing parents, a thorough physical evaluation, routine laboratory tests, and cardiorespiratory monitoring. A variety of further investigations were usually performed to look for gastroesophageal reflux (GER), vagal hyperreflectivity, or sleep-related cardiorespiratory disorders. Leading causes, that often occurred in combination, included GER (66 per cent of cases), and vagal hyperreflectivity (13%). Atypical breath-holding spells, ENT causes, and neurological causes were documented in 8%, 6% and 5% of cases respectively. Medical treatment of the GER proved effective in 90% of cases. Metoclopramide (Primperan, 10 drops/kg/d) was effective in 62% of infants with GER and was well tolerated. Diphemanil methylsulfate (Prantal, 10 mg/kg/d) satisfactorily controlled vagal hyperreflectivity. Monitoring was prescribed in 43% of cases.
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PMID:[Apropos of 100 cases of malaise in infants]. 281 99

Gastroesophageal reflux (GER) during infancy is a disorder of unknown etiology which may be associated with abnormalities of upper gastrointestinal motor function. Bethanechol, a muscarinic agonist, and metoclopramide, a dopamine antagonist, have been utilized as pharmacologic agents in an attempt to improve upper gastrointestinal motility in this disorder. We have studied the effect of these agents on upper gastrointestinal motility in an infant model, the kitten. Bethanechol is found to greatly increase lower esophageal sphincter (LES) pressure and have no effect on esophageal peristaltic amplitude or gastric emptying of a liquid meal. Metoclopramide causes a small and nonsignificant increase in LES pressure, has no effect on esophageal peristalsis, and increases the rate of gastric emptying of a liquid meal. These results suggest that these two agents may have specific actions on the infant's upper gastrointestinal tract.
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PMID:Effect of bethanechol and metoclopramide on upper gastrointestinal motility in the kitten. 286 86

Gastroesophageal reflux (GER) disease is a common, multifactorial medical condition that may be difficult to treat. Simple lifestyle modifications decrease reflux episodes and should serve as the cornerstone for medical therapy. Antacids or alginic acid may be helpful in mild disease but recent studies suggest they may be no better than placebo. Metoclopramide improves symptomatic GER disease but side effects are a major limiting factor. Only bethanechol and the histamine H2 antagonists have been conclusively shown to improve esophagitis significantly. Therefore, more severe disease is currently best treated with a histamine H2 antagonist alone or in combination with bethanechol. The treatment of GER complications and maintenance therapy have only been recently addressed in clinical trials, but again the histamine H2 antagonists may have a useful role. Five to 10% of patients may require antireflux surgery, but the competency of the repair appears to deteriorate with time. Future clinical trials need to address specific areas of difficulty including entry criteria, test of efficacy, study duration, and usefulness of combination drug therapy.
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PMID:A critical review of current medical therapy for gastroesophageal reflux disease. 287 68

The aim of this study was to analyze the results and the quality of methodology of 51 controlled double blind trials in the medical treatment of gastroesophageal reflux. The results of H2 receptor antagonist treatment were evaluated by the pooling method. Evaluation of methodology was carried out by using a special form filled in by two independent observers. The major criticisms in methodology were: small sample size, unblind evaluation of end-points, inappropriate statistical tests for small samples, and inaccurate handling of the withdrawals. There were only two trials concerning antacids versus placebo: one showed that Novaluzid improved symptoms and another that Maalox did not differ from placebo. The effectiveness of alginic acid and domperidone on either symptoms or endoscopic lesions was not demonstrated. Metoclopramide and bethanechol produced significant relief of reflux symptoms. Sucralfate and bethanechol were better than placebo in improvement of esophagitis endoscopic lesions. The H2-inhibitors efficiently relieved symptoms and esophagitis. Pooling analysis showed that H2-inhibitors were superior to placebo in the healing of esophagitis; the odds ratios were 2.5 for cimetidine and 3.3 for ranitidine, without significant difference. Omeprazole was better than ranitidine in relief of symptoms and esophagitis. The comparison of cimetidine alone with cimetidine plus metoclopramide showed that combined therapy was better in one trial out of two. New controlled trials are necessary to compare these different drugs and their association.
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PMID:[Treatment of gastroesophageal reflux: analysis of randomized double-blind trials]. 289 80

The pharmacokinetics and pharmacodynamics of metoclopramide oral solution were evaluated in six infants (0.9-5.4 months) with gastroesophageal reflux (GER) following the initial and 10th dose of 0.15 mg/kg administered every 6 h. Metoclopramide pharmacodynamics were assessed by pre- and post-dose comparison of esophageal pH monitoring data and clinical evaluation of improvement in GER symptoms. A significant reduction in the number of episodes of pH less than 4 for greater than 5 min and the longest episode of GER was seen between the predose and 10th dose (steady-state) evaluation periods. Four of the 6 patients had a 75% reduction in reflux time and demonstrated improvement in clinical symptoms by the 10th dose. Metoclopramide pharmacokinetics were best characterized by a one-compartment open model following the first and 10th doses. Metoclopramide serum concentrations (mean +/- SD) ranged from 56.2 +/- 23.5 to 32.7 +/- 13.2 ng/ml within a 6-h dosing interval at steady state. There were no significant differences between the first versus tenth dose values for Tmax (2.0 +/- 0.5 versus 2.2 +/- 0.4 h), Kel (0.14 +/- 0.03 versus 0.17 +/- 0.04 h-1), Vdarea (4.9 +/- 0.4 versus 4.4 +/- 0.6 L/kg), or clearance (0.66 +/- 0.16 versus 0.67 +/- 0.13 L/h/kg). The youngest subject (3.5 weeks) had a metoclopramide t 1/2 of 23.1 h following initial dose, which decreased to 10.3 h at steady-state. Care should be exercised in using the 0.15 mg/kg dose in infants less than 1 month of age as prolonged clearance may produce excessive serum concentrations.
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PMID:Metoclopramide pharmacokinetics and pharmacodynamics in infants with gastroesophageal reflux. 319 69

This study examined the effect of metoclopramide on lower esophageal sphincter (LES) pressure, and frequency and duration of reflux episodes in 28 children (mean age (+/- SD) 9 +/- 11 months) referred for evaluation of gastroesophageal reflux (GER). Esophageal manometry was performed before and after one intravenous dose of metoclopramide (0.125 mg/kg), and esophageal pH was monitored over a 24-hour baseline period, followed by oral metoclopramide therapy (0.125 mg/kg four times a day, for 24 hours.) During pH monitoring, patients received diet for age and were kept in the prone position with the head elevated 45 degrees while sleeping. Eight patients entered a 6-month double-blind, placebo-controlled trial of metoclopramide. Metoclopramide significantly (P = 0.04) increased end-expiratory LES pressure, from 14.9 +/- 7.5 mm Hg to 18.6 +/- 6.8 mm Hg. However, there was a significant (P less than 0.05) increase in the number of reflux episodes/24 hours, and no significant change in percentage of time pH was less than 4, number of episodes lasting greater than 5 minutes, or the longest episode of reflux between the 24-hour baseline and M periods. LES pressure did not correlate well with any of these measurements (r = 0.2). In the controlled trial, the three patients receiving metoclopramide, but none of those receiving placebo, were withdrawn by their parents because of exacerbation of GER symptoms and marked irritability (P = 0.01). In the placebo group, symptoms improved in four infants, but did not change in one. The use of metoclopramide in the treatment of GER of infancy needs to be reconsidered.
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PMID:Metoclopramide in gastroesophageal reflux of infancy. 334 92

Metoclopramide has wide applications in both clinical and experimental medicine. It is useful in the management of gastro-oesophageal reflux and gastric stasis. It is being used increasingly in the management of nausea and vomiting, and at high doses will significantly relieve the emesis that is induced by cytotoxic agents. Metoclopramide also has an important place in the investigation of the role of dopamine in physiological and pathological processes.
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PMID:Metoclopramide--a review. 351 36


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