The effect of a single rectal dose of cisapride on delayed gastric emptying

BACKGROUND

Cisapride has an established prokinetic effect in patients with delayed gastric emptying. However, rectal administration of the drug might be preferred in patients with either dysphagia or nausea due to gastroparesis.

AIM

To determine the effect of a single rectal dose of cisapride 60 mg on gastric emptying in patients with delayed gastric emptying.

METHODS

Thirty-two patients (16 males, 16 females) with demonstrated delayed gastric emptying received a single dose of two suppositories containing either cisapride (2 x 30 mg) or placebo, according to a double-blind randomized crossover design. Three hours after administration of the suppositories, the patients received a radio-labelled test meal and radio-opaque markers for measurement of gastric emptying.

RESULTS

The mean t1/2 after cisapride administration (76 min, 95% CI: 68-95) was significantly shorter (P = 0.005: n = 28, per-protocol analysis) than after placebo administration (104 min, 81-126). Four hours after ingestion of the meal significantly fewer radio-opaque markers remained in the stomach after cisapride than after placebo administration (P < 0.05). Mild to moderate adverse events, mainly involving the gastrointestinal tract, were reported in 10 patients (31%) after cisapride treatment and in four patients (13%) after placebo (N.S.: n = 32).

CONCLUSION

A single suppository dose of cisapride 60 mg significantly accelerates gastric emptying of the solid phase of a meal and of radio-opaque markers in patients with previously demonstrated delayed gastric emptying.

Perfusion imaging of pancreas allografts using technetium-99m hexamethyl propylene amine oxime

The vascular integrity and major changes in perfusion can be determined by visual interpretation of radionuclide flow studies. We studied the potential of a new radiopharmaceutical technetium-99m hexamethyl propylene amine oxime (99mTc-HMPAO) in the particular setting of pancreas transplantation. Perfusion was measured by perfusion indices (PI). Changes in graft perfusion were estimated by three independent observers. A predefined scale from 0 to 4 was used, with 0 representing no visualisation of the graft and 4 denoting sharp countour delineation and distinct demarcation from the background. In order to investigate the relation between perfusion of the pancreas graft and its exocrine function, we measured the amylase excretion rate (AER) in the urine, expressed in units per hour. It is concluded that 99mTc-HMPAO is a suitable radiopharmaceutical for pancreas allograft imaging. For the assessment of the vascular integrity in the direct postoperative period, the scintigram is very reliable. Although a correlation between exocrine function of the graft and the perfusion score was not established, it is possible to make a clear sorting of AER measurements into different groups.