Document Detail


Cisapride improves enteral tolerance in pediatric short-bowel syndrome with dysmotility.
MedLine Citation:
PMID:  21502831     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVES: Gastrointestinal dysmotility is common in pediatric short-bowel syndrome, leading to prolonged parenteral nutrition dependence. There is limited literature regarding the safety and efficacy of cisapride for this indication. The aim of the study was to describe the safety and efficacy of cisapride for enteral intolerance in pediatric short-bowel syndrome.
METHODS: Open-labeled pilot study in a limited access program for cisapride. Indications were short-bowel syndrome with underlying dysmotility and difficulty advancing enteral feeds despite standard therapies and without evidence of anatomic obstruction. Patients received cisapride 0.1 to 0.2 mg/kg per dose for 3 to 4 doses per day. We collected electrocardiogram, nutrition, and anthropometric data prospectively at study visits.
RESULTS: Ten patients with mean (SD) age of 30.3 (30.5) months were enrolled in our multidisciplinary pediatric intestinal rehabilitation program. Median (interquartile range [IQR]) duration of follow-up was 8.7 (3.1-14.3) months. Median (IQR) residual bowel length was 102 (85-130) cm. Median (IQR) citrulline level was 14.5 (10.5-31.3) μmol/L. Diagnoses included isolated gastroschisis (n = 3), gastroschisis with intestinal atresia (n = 4), necrotizing enterocolitis (n = 2), and long-segment Hirschsprung disease (n = 1). Six subjects had at least 1 prior bowel-lengthening procedure. Median (IQR) change in percentage enteral energy intake was 19.9% (15.4%-29.8%) during follow-up (P = 0.01). Seven patients improved in enteral tolerance during treatment and 2 were weaned completely from parenteral nutrition. Complications during therapy were prolonged corrected QT interval (n = 2), gastrointestinal bleeding (n = 2), D-lactic acidosis (n = 1), and death due to presumed sepsis (n = 1). Longitudinal analysis (general estimating equation model) showed a strong positive association between cisapride duration and improved enteral tolerance. Mean percentage of enteral intake increased by 2.9% for every month of cisapride treatment (P < 0.0001).
CONCLUSIONS: Cisapride is a potentially useful therapy in patients with pediatric short-bowel syndrome with gastrointestinal dysmotility. We observed modest improvement in feeding tolerance where prior treatments failed; however, patients treated with cisapride require careful cardiac monitoring because corrected QT prolongation occurred in 20% of our cohort.
Authors:
Bram P Raphael; Samuel Nurko; Hongyu Jiang; Kristen Hart; Daniel S Kamin; Tom Jaksic; Christopher Duggan
Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of pediatric gastroenterology and nutrition     Volume:  52     ISSN:  1536-4801     ISO Abbreviation:  J. Pediatr. Gastroenterol. Nutr.     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-04-19     Completed Date:  2011-12-02     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  8211545     Medline TA:  J Pediatr Gastroenterol Nutr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  590-4     Citation Subset:  IM    
Affiliation:
Center for Advanced Intestinal Rehabilitation, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Child
Child, Preschool
Cisapride / therapeutic use*
Citrulline / blood
Energy Intake*
Enteral Nutrition / adverse effects,  methods*
Enterocolitis, Necrotizing / therapy
Female
Follow-Up Studies
Gastrointestinal Agents / therapeutic use*
Gastrointestinal Motility*
Gastroschisis / therapy
Hirschsprung Disease / therapy
Humans
Infant
Intestinal Atresia / therapy
Intestine, Small / pathology
Male
Parenteral Nutrition
Pilot Projects
Short Bowel Syndrome / drug therapy,  physiopathology,  therapy*
Treatment Outcome
Grant Support
ID/Acronym/Agency:
1K24HD058795/HD/NICHD NIH HHS; K24 HD058795/HD/NICHD NIH HHS; K24 HD058795-01A2/HD/NICHD NIH HHS; K24DK082792A/DK/NIDDK NIH HHS; P30 DK040561-15/DK/NIDDK NIH HHS; T32DK007477-25/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Gastrointestinal Agents; 372-75-8/Citrulline; 81098-60-4/Cisapride
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Management of Button Battery-induced Hemorrhage in Children.
Next Document:  Challenges of transitioning from a faculty to an administrative role: part 3, from solving problems ...