Prokinetic Agents for GERD

Prokinetic Agents for GERD

It is very important to know about what medicine is given by the doctor, for what condition, and when it needs to be taken in what dose. This information given by the doctor is called Prescription. The patients should be familiar with the medicine prescription, and the details about the medicine before purchasing it and using it.

This was welcome news for people suffering with severe gut dysmotilities. The extent of relief is early and more prominent with levosulpiride than itopride.

The classification of functional dyspepsia has been proposed as dysmotility-like, reflux-like, ulcer-like and nonspecific groups 21) . Although the classification of functional dyspepsia patients into these groups was a purely arbitrary and did not reflect the pathophysiologic mechanisms of functional dyspepsia, our results showed that dysmotility-like and nonspecific groups had a more delayed gastric emptying than reflux-like and ulcer-like groups.

Gastroenterologists then began using tegaserod for the treatment of gastroparesis and chronic intestinal pseudo-obstruction. As well, Novartis was able to demonstrate effective treatment of slow-transit constipation with tegaserod and subsequently received marketing approval for the new application. However, one very serious side effect from the dopamine receptor blocking drugs is a central nervous system side effect called tardive dyskinesia (tardive meaning late onset, and dyskinesia meaning abnormal muscle movements). This more serious, potentially non-reversible side effect shows up after months or years of treatment.

levosulpiride for gerd

Patients diagnosed to have gastroesophageal reflux (with the necessary inclusion and exclusion criteria) were given a trial of conservative management (lifestyle changes and medications). Lifestyle changes included eating a low-fat, bland vegetarian diet, assuming an upright (head high/propped up) position while sleeping, abstaining from tea/coffee/alcohol, and avoiding a sedentary lifestyle. After this trial, it has become necessary to compare the effects of levosulpiride with other prokinetic agents.

Other studies have shown that mosapride does accelerate gastric emptying while also improving small bowel and colon transit. Mosapride has been studied in the treatment of constipation in people with Parkinson’s disease. Like cisapride, mosapride shows promotility action throughout the whole GI tract.

3)Eat slowly. 4)Use a slight high pillow when lying down. 5) Take isabgol husk 2-3 tsf with luke warm water at regular basis.

First developed in the 1950s, erythromycin was not used in gastroenterology until some decades later16. Numerous studies have proven that this antibiotic is highly effective at producing peristaltic contractions in the stomach antrum17. This effect is gained at very low doses (lower doses than those needed for an antibiotic effect)17. In reality, it produces a dumping syndrome in the stomach (emptying too rapidly).

levosulpiride for gerd

For some patients, tegaserod was highly effective in the treatment of slow-transit constipation. Without tegaserod, unmanageable constipation would require surgical removal of the colon for some patients. Approximately 60% of patients have minimal side effects and can tolerate this drug. Others have to discontinue this medication due to bothersome side effects such as fatigue or a feeling of agitation, and in rare cases, as already mentioned, abnormal muscle movements, or what is called tardive dyskinesia.

CONCLUSION-Dyspepsia is a frequently occurring complaint in primary care and patients are usually treated by their GP. Besides clinically relevant reasons for referral, dyspeptic patients with irritable bowel syndrome seem to be more “at risk” of being referred to secondary care than other dyspeptic patients. The differences between primary and secondary care dyspeptic patients should be taken into account when interpreting research for guideline purposes. Further research is needed to clarify the background of the relation between irritable bowel syndrome and dyspepsia and its influence on referral.

Psychiatry finally had some medical tools to help these patients. It was soon realized that this category of drugs also had a wide application.

In the study done by Nagpal et al. [4], the most common symptom was heartburn, followed by regurgitation and constipation [4]. In a study of 107 patients done by Balsara et al. [6], the symptoms on presentation were heartburn in all (100%), regurgitation in 43 (50.59%), and volume reflux in 39 (45.88%) patients [6]. Effect of chronic administration of cisapride on gastric emptying of a solid meal and on dyspeptic symptoms in patients with idiopathic gastroparesis. Effects of Levo-sulpiride on the kinetics of gallbladder emptying and duodenal-gastric reflux in patients with diopathic alkaline gastritis.

This might explain why individuals that need to use this drug for its antibiotic effect have a good number of side effects such as nausea and abdominal cramping. This particular prokinetic is frequently used in pre-term infants who have delayed gastric emptying.

This broad category of drugs has been around for a long time. The phenothiazine drugs were brought into use for psychiatry in the late 1940s and early 1950s. The medical management of psychiatric patients really started to blossom in this era.

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