Rationale for dyspepsia - Drug treatment for patients with functional dyspepsia is still controversial even if antisecretory agents such as histamine antagonists and proton pump inhibitors are the most used agents. For patients with symptoms suggesting upper gastrointestinal (Gl) dysmotility, prokinetics such as cisapride have been largely used and current meta-analyses indicate that they exhibit a potent efficacy (1).
Serotonergic agents - The most widely known serotonergic agent used for the treatment of dyspepsia is a mixed 5-HT3 antagonist and 5-HT4 agonist, cisapride (i). Both 5-HT3 and 5-HT4 receptors are involved in the control of gut motility. They are located on afferent nerves pre- or post-synaptically, enhancing the release of acetylcholine (Ach) and substance P (SP) in response to afferent nerve stimulation
Cisapride has been reported to accelerate gastric emptying in both normal patients and those with gastric motor abnormalities (3). Its role in stimulating gastric emptying and improving symptoms in patients with gastroparesis has been studied extensively. The motility effect is most likely due to its 5-HT4 agonist effects facilitating acetylcholine release. Along with its ability to increase antral contractility, cisapride has many other physiological effects in the stomach. It has been shown to relieve gastric outlet obstruction in patients with diabetic autonomic dysfunction, possibly through its ability to affect inhibitory nitrergic transmission (4). It can also affect fundic relaxation and accomodation in response to meals, and may counteract enteric negative feedback in response to intraduodenal lipids (4).
Cisapride has been reported to accelerate gastric emptying in several gastroparetic syndromes (5). Its efficacy in controlling symptoms, however, is controversial. The effect of cisapride on gastric emptying in 22 patients with
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Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.