Document Detail


Effects of cisapride on gall bladder emptying, intestinal transit, and serum deoxycholate: a prospective, randomised, double blind, placebo controlled trial.
MedLine Citation:
PMID:  11709518     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Octreotide inhibits gall bladder emptying and prolongs intestinal transit. This leads to increases in the proportion of deoxycholic acid in, and cholesterol saturation of, gall bladder bile, factors that contribute to the pathogenesis of octreotide induced gall stones. AIMS: To see if an intestinal prokinetic, cisapride, could overcome these adverse effects of octreotide and if so, be considered as a candidate prophylactic drug for preventing iatrogenic gall bladder stones. METHODS: A randomised, double blind, placebo controlled, crossover design was used to examine the effects of cisapride (10 mg four times daily) on gall bladder emptying, mouth to caecum and large bowel transit times, and the proportions of deoxycholic acid and other bile acids, in fasting serum from: (i) control subjects (n=6), (ii) acromegalic patients not treated with octreotide (n=6), (iii) acromegalics on long term octreotide (n=8), and (iv) patients with constipation (n=8). RESULTS: Cisapride had no prokinetic effect on the gall bladder. In fact, it significantly increased both fasting and postprandial gall bladder volumes. However, it shortened mouth to caecum (from 176 (13) to 113 (11) minutes; p<0.001) and large bowel (from 50 (3.0) to 31 (3.4) h; p<0.001) transit times. It also reduced the proportion of deoxycholic acid in serum from 26 (2.3) to 15 (1.8)% (p<0.001), with a reciprocal increase in the proportion of cholic acid from 40 (3.5) to 51 (3.8)% (p<0.01). There were significant linear relationships between large bowel transit time and the proportions of deoxycholic acid (r=0.81; p<0.001) and cholic acid (r=-0.53; p<0.001) in fasting serum. INTERPRETATION/SUMMARY: Cisapride failed to overcome the adverse effects of octreotide on gall bladder emptying but it countered octreotide induced prolongation of small and large bowel transit. Therefore, if changes in intestinal transit contribute to the development of octreotide induced gall bladder stones, enterokinetics such as cisapride may prevent their formation.
Authors:
M J Veysey; P Malcolm; A I Mallet; P J Jenkins; G M Besser; G M Murphy; R H Dowling
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Gut     Volume:  49     ISSN:  0017-5749     ISO Abbreviation:  Gut     Publication Date:  2001 Dec 
Date Detail:
Created Date:  2001-11-15     Completed Date:  2001-12-28     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  2985108R     Medline TA:  Gut     Country:  England    
Other Details:
Languages:  eng     Pagination:  828-34     Citation Subset:  AIM; IM    
Affiliation:
Gastroenterology Unit, Guy's Hospital Campus, GKT School of Medicine, Kings College, London, UK.
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MeSH Terms
Descriptor/Qualifier:
Acromegaly / drug therapy
Adult
Cholelithiasis / prevention & control
Cholic Acid / blood
Cisapride / therapeutic use*
Constipation / drug therapy
Cross-Over Studies
Deoxycholic Acid / blood*
Double-Blind Method
Female
Gallbladder Emptying / drug effects*
Gastrointestinal Agents / therapeutic use*
Gastrointestinal Transit / drug effects*
Humans
Male
Middle Aged
Octreotide / adverse effects,  therapeutic use
Prospective Studies
Regression Analysis
Chemical
Reg. No./Substance:
0/Gastrointestinal Agents; 81-25-4/Cholic Acid; 81098-60-4/Cisapride; 83-44-3/Deoxycholic Acid; 83150-76-9/Octreotide
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