Influence of prucalopride on esophageal secondary peristalsis in reflux patients with ineffective motility.

Abstract

Ineffective esophageal motility (IEM) is associated with gastroesophageal reflux disease. Secondary peristalsis contributes to esophageal clearance. Prucalopride promotes secondary peristalsis by stimulating 5-hydroxytrypatamine 4 receptors in the esophagus. We aimed to determine whether prucalopride would augment secondary peristalsis in gastroesophageal reflux disease patients with IEM. After a baseline recording of primary peristalsis, secondary peristalsis was stimulated by slow and rapid mid-esophageal injections of air in 15 patients with IEM. Two separate sessions with 4-mg oral prucalopride or placebo were randomly performed. Prucalopride significantly increased primary peristaltic wave amplitude (68.1±10.0 vs 55.5±8.8mmHg, P=0.02). The threshold volume for triggering secondary peristalsis was significantly decreased by prucalopride during slow (9.3±0.8 vs 12.0±0.8mL; P=0.04) and rapid air injection (4.9±0.3 vs 7.1±0.1mL; P=0.01). Secondary peristalsis was triggered more frequently after application of prucalopride (55% [43-70%]) than placebo (45% [33-50%]) (P=0.008). Prucalopride did not change pressure wave amplitudes during slow air injection (84.6±8.1 vs 57.4±13.8mmHg; P=0.19) or pressure wave amplitudes during rapid air injection (84.2±8.6 vs 69.5±12.9mmHg; P=0.09). Prucalopride enhances primary peristalsis and mechanosensitivity of secondary peristalsis with limited impact on secondary peristaltic activities in IEM patients. Our study suggests that prucalopride appears to be useful in augmenting secondary peristalsis in patients with IEM only via sensory modulation of esophageal secondary peristalsis.