Determinants of response to a prokinetic agent in neuropathic chronic intestinal motility disorder

Background/Aims: Reasons for the variable efficacy of prokinetic agents in the treatment of chronic intestinal motility disorders are unclear. The aim of this study was to assess the influence of extrinsic autonomic neuropathy and motility patterns on the symptom response to cisapride in 42 such patients. Methods: A randomized, double-blind, placebo-controlled, two-dose (10 and 20 mg, three times daily), 12-week study included (1) measurement of autonomic (including abdominal vagal) function; (2) standardized 5-hour upper gastrointestinal manometry; and (3) assessment of symptoms based on visual analog scale at baseline and 6 and 12 weeks. Statistical analysis compared symptom response among treatment and autonomic dysfunction groups and assessed the influence of absence of migrating motor complexes and presence of postprandial antral hypomotility on symptomatic responses to cisapride. Results: There was no significant overall effect of cisapride in the entire group of 42 patients. Generalized sympathetic and vagal dysfunctions influence the response of patients with neuropathic chronic intestinal motility disorder to two doses of cisapride. Conclusions: Idiopathic intestinal motility disorder, unassociated with abdominal vagal dysfunction, is more likely to respond to cisapride. Detailed characterization of patient subgroups is crucial to designing treatment trials in patients with small bowel motility disorders.