Intramuscular Metoclopramide Research Articles

Sonographic diagnosis of intramural duodenal hematoma.

A previously healthy 2-year-8-month-old boy was brought to the emergency department due to non-bilious vomiting several times in one day. Refractory vomiting persisted after fasting with intramuscular metoclopramide use. On evaluation, the patient appeared mildly anxious and showed no signs of acute abdomen. The vital signs were as follows: temperature 36.9 °C, blood pressure 122/64 mmHg, pulse 86 beats/min, respiratory rate 20 breaths/min, and oxygen saturation 100% breathing ambient air. Abdominal sonography revealed a heterogeneous mass lesion along the duodenal convexity with a size of 44.2∗12.3∗13.6 mm (Fig. 1), accompanied with several hypoechoic heterogeneous lesions at the right subphrenic area.

Megaesophagus in Mule

Background: Megaesophagus is a chronic dilation of the esophagus rarely found in horses. It’s a non-specific disease that is associated with several causes, and esophageal hypomotility is the dysfunction that most commonly results in organ dilation. In the literature, there are few reports of megaesophagus in horses and, to date, no cases in mule have been reported. The objective of this work is to describe a case of a donkey with thoracic megaesophagus.Case: A 16 year-old donkey, castrated male, mixed breed weighing 195 kg, was referred for clinical care with a history of 5 days of anorexia. On physical examination, apathy, cachexia, 8% dehydration, moderate enophthalmos, ptialism, bilateral nasal discharge, dry and bristling hair were observed. Due to the poor general condition, a nasogastric tube was chosen to perform enteral nutrition, however, it was not possible to progress the tube to the stomach. In order to confirm the suspicion of a possible esophageal obstruction, gastroscopy was performed, where it was possible to observe an esophageal dilation filled with bulky food located in the thoracic portion of the esophagus. In an attempt to stimulate esophageal motility, in order to promote the progression of the material present in the region of dilation, intramuscular metoclopramide was administered (two applications every 6 h), however the treatment had no effect. Due to the unfavorable prognosis and financial limitations of the owner, euthanasia was performed, which was followed by autopsy and histopathological examination. At necropsy, a marked dilation of the esophagus was observed in the thoracic portion, which was filled with approximately 500 grams of bulky food (grass). In the mucosa of this area, multiple ulcers were observed that occasionally coalesce, covered by a moderate amount of friable and yellowish-white material.Discussion: Megaesophagus is characterized by organ dilatation and enlargement, absence of peristalsis, presence of tertiary contractions and non-total or partial relaxation of the lower sphincter. Its origin can be congenital or secondary (acquired). In the congenital form, which corresponds to the hypomotility and generalized dilation of the esophagus, the main consequence is the underdevelopment of the foal after weaning. The acquired form occurs due to motor changes in the esophagus or gastroesophageal sphincter, causing passive dilation of the organ. Lupus erythematosus, polymyositis, polyneuritis, degenerative neuropathies, hypoadrenocorticism, hypothyroidism, thiamine deficiency, heavy metal poisoning (Lead and Thallium), tumors (mainly thymoma) and cervical injuries are among the main causes of secondary megaesophagus. Animals with esophageal paralysis or some type of esophageal obstruction, usually present nasal and oral reflux of saliva and may develop aspiration pneumonia, accompanied by nutritional deficiencies, weight loss, changes in normal development and the presence of esophageal ulcers. With the exception of pneumonia, the animal in the present report had all these signs. The prognosis of animals affected by megaesophagus is unfavorable. One of the ways to alleviate this disease is surgical treatment, however, complications such as dehiscence are common after esophageal surgery, mainly due to the fact that this organ does not have a serous layer, resulting in delayed healing. For this reason, euthanasia is considered in most cases. Megaesophagus is a non-specific and multifactorial disease that affects horses, and there are no reports in the literature in mules. In this case, endoscopy allowed the diagnosis to be made while still alive, however it was not possible to determine the primary cause of the disease.

Prevention of Post-cesarean Nausea and vomiting by Intramuscular Metoclopramide: A Randomized Clinical trial

Background & aim: Nausea and vomiting are considered as the main post-cesarean complications in women undergoing cesarean section. Therefore, the present study aimed to examine the efficacy of intramuscular metoclopramide before cesarean section to prevent post-cesarean nausea and vomiting. Methods: Study population in the present study consisted of 617 women scheduled for cesarean section. The participants were randomly divided into intervention and control groups. The intervention group received 10 mg intramuscular metoclopramide prior to the surgery, compared to the control group taking an aquatic neutral placebo. Nausea, vomiting, feeling of hunger, and eating time were assessed postoperatively using a visual analog scale every 4 hour. Data were analyzed using the Chi-square test and t-test in SPSS software (version 17). Results: During 12-hour postoperative observation, the incidence and intensity of nausea were lower in the metoclopramide group (P=0.005). Metoclopramide group clearly needed a less severe therapeutic approach for nausea (14% vs. 44%). Furthermore, participants in the intervention group showed a decline in vomiting; however, this decline was not significant (P=0.4). The metoclopramide group developed the feeling of hunger and eating sooner than those in the control group (P=0.003, P=0.002, respectively). None of the participants reported any side effects of this medication. Conclusion: The intramuscular injection of 10 mg metoclopramide before cesarean section decreased the incidence and intensity of nausea as well as discharge time from the hospital. Metoclopramide is recommended as a safe, available, and inexpensive medication, which can result in a higher level of maternal health and shorter period of hospitalization.

Biochemical profile in dairy cows with artificial induction of lactation

ABSTRACT: The objective of this study was to determine the biochemical profile of dairy cows with induced lactation. For comparison, another group of normally calved cows was used as control. Lactation was induced in multiparous Holstein cows (n=10) with two norgestomet implants (3mg each implant) on day 1. The testing continued with intramuscular norgestomet (3mg/animal) on days 1, 3, 5, 7, 9, 11, 13 and 15. On days 1, 9, 16 to 18 and then every 14 days, bSTr (500mg/animal) was added. On day 16, the intravaginal implant was removed and intramuscular prostaglandin F2α (0.530mg/animal) and intramuscular estradiol benzoate (5mg/animal) were added. On days 16 to 18 dexamethasone (10mg/animal) was added, and from days 18 to 20 intramuscular metoclopramide (100mg/animal) was added. Milking began on day 19 of the induction. Blood was collected for a biochemical profile after 21 days in milk. It was found that urea and triglyceride concentrations were significantly higher in the induced cows (P<0.05). Therefore, it was concluded that the animals that had lactation induced did not present disorders related to the biochemical profile indicating that the hepatic function, renal function and lipidogram of the animals were not affected by the use of the drugs to induce lactation.

Does magnetically assisted capsule endoscopy improve small bowel capsule endoscopy completion rate? A randomised controlled trial.

Background and study aims: Delayed gastric emptying is a significant factor in incomplete small bowel capsule examinations. Gastric transit could be hastened by external magnetic control of the capsule. We studied the feasibility of this approach to improve capsule endoscopy completion rates. Patients and methods: Prospective, single-center, randomized controlled trial involving 122 patients attending for small bowel capsule endoscopy using MiroCam Navi. Patients were randomized to either the control group (mobilisation for 30 minutes after capsule ingestion, followed by intramuscular metoclopramide 10 mg if the capsule failed to enter the small bowel) or the intervention group (1000 mL of water prior to capsule ingestion, followed by positional change and magnetic steering). Outcome measures were capsule endoscopy completion rate, gastric clarity and distention, relationship of body habitus to capsule endoscopy completion rate (CECR), and patient comfort scores. Results: 122 patients were recruited (61 each to the control and intervention groups: mean age 49 years [range 21 – 85], 61 females). There was no significant difference in CECR between the two groups (P = 0.39). Time to first pyloric image was significantly shorter in the intervention group (P = 0.03) but there was no difference in gastric transit times (P = 0.12), suggesting that magnetic control hastens capsular transit to the gastric antrum but does not influence duodenal passage. Gastric clarity and distention were significantly better in the intervention group (P < 0.0001 and P < 0.0001 respectively). Conclusions: Magnetic steering of a small bowel capsule is unable to overcome pyloric contractions to enhance gastric emptying and improve capsule endoscope completion rate. Excellent mucosal visualisation within the gastric cavity suggests this technique could be harnessed for capsule examination of the stomach.

Metoclopramide for post-pyloric placement of naso-enteral feeding tubes.

Enteral nutrition by feeding tube is a common and efficient method of providing nutritional support to prevent malnutrition in hospitalised patients who have adequate gastrointestinal function but who are unable to eat. Gastric feeding may be associated with higher rates of food aspiration and pneumonia than post-pyloric naso-enteral tubes. Thus, enteral feeding tubes are placed directly into the small intestine rather than the stomach, and the use of metoclopramide, a prokinetic agent, has been recommended to achieve post-pyloric placement, but its efficacy is controversial. Moreover, metoclopramide may include adverse reactions, which with high doses or prolonged use may be serious and irreversible. To determine the effect of intravenous metoclopramide on post-pyloric placement of the naso-enteral tube in adults. Trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 10) which includes the CUGPD group's specialised register of trials, MEDLINE (1996 to 21 October 2014), EMBASE (1988 to 21 October 2014), LILACS (2005 to 21 October 2014) We did not confine our search to English language publications. Searches in all databases were updated originally in January 2005, then in November 2008 and again in October 2014. No new studies were found in 2008 or in 2014. We selected randomised controlled trials of adults needing enteral nutrition, who received intravenous or intramuscular metoclopramide to aid placement of transpyloric naso-enteral feeding tubes, compared to placebo or no intervention. We used standard methodological procedures expected by The Cochrane Collaboration. All analyses were performed according to the intention-to-treat method. We present risk ratios (RR) with 95% confidence intervals (CI). Four studies, with a total of 204 participants were included and analysed. The trials compared metoclopramide with placebo (two trials) or with no intervention (two trials). Metoclopramide was investigated at doses of 10 mg (two trials) and 20 mg (two trials). There was no statistically significant difference between metoclopramide versus placebo or no intervention administered to promote tube placement (RR 0.82, 95% CI 0.61 to 1.10). Metoclopramide at doses of 10 mg (RR 0.82, 95% CI 0.60 to 1.11) and 20 mg (RR 0.62, 95% CI 0.15 to 2.62) were equally ineffective in facilitating post-pyloric intubation when compared with placebo or no intervention. In this review, we found only four studies that fitted our inclusion criteria. These were small, underpowered studies, in which metoclopramide was given at doses of 10 mg and 20 mg. Our analysis showed that metoclopramide did not assist post-pyloric placement of naso-enteral feeding tubes.Ideally randomised clinical trials should be performed that have a significant sample size, administering metoclopramide against control, however, given the lack of efficacy revealed by this review it is unlikely that further studies will be performed.

Long-lasting adverse effects after short-term low-dose treatment with metoclopramide for vomiting

Metoclopramide is commonly used to treat vomiting caused by seasickness and acute gastroenteritis on cruise ships and serious adverse effects have not been reported from use at sea. We report severe long-lasting adverse effects in a young female seafarer following short-term, low-dose use of metoclopramide. During rough seas a 25-year-old female musician on a cruise vessel presented with nausea and vomiting. She was given intramuscular metoclopramide 10 mg and diphenhydramine 25 mg. Vomiting stopped after the injections, but she felt tired, confused and dizzy. She then had been taking metoclopramide 5-10 mg a day, but stopped after a total per oral dose of 30 mg as she developed disturbing symptoms that she related to the medication, including dizziness, anxiety, fatigue, depression and involuntary movements (twitches, jerks, ticks, and tremors of the eyelids, tongue, neck, fingers, arms and legs). Neurological examination, blood tests, electrocardiography and magnetic resonance imaging of the brain were all normal. Although gradually reduced in strength and frequency, the adverse effects were very disturbing for about 10 months, but at 13 months she was almost fully recovered. For many years numerous vomiting sea travellers have been successfully treated with a single parenteral 10 mg dose of metoclopramide. There are no obvious reasons why our previously healthy patient experienced such serious and long-lasting side effects after low-dose, short-term metoclopramide administration. Until more is known, metoclopramide should be reserved for debilitating cases - and only be given after other remedies have been tried and found ineffective.

A randomized open-label study of sodium valproate vs sumatriptan and metoclopramide for prolonged migraine headache

ObjectiveThe objective of this study is to compare the efficacy and tolerability of intravenous valproic acid (iVPA) with intramuscular metoclopramide + subcutaneous (SQ) sumatriptan for prolonged acute migraine. BackgroundIntravenous valproic acid has been explored as a possible treatment of acute migraine. Sumatriptan and newer generation triptans are also effective for migraine. However, iVPA has not yet been compared with triptans in head-to-head studies. MethodsPatients presenting with moderate to severe intensity migraine without aura were randomized to receive either 400 mg of iVPA or 10 mg intramuscular metoclopramide + 6 mg SQ sumatriptan (30 patients in each study arm). The severity of headache and other associated symptoms such as photophobia and phonophobia were assessed at baseline and after 20 minutes and 1, 2, 4, and 24 hours. The primary end point was to compare the efficacy of the 2 study treatments in relieving headache from moderate-severe to none-mild and of other associated symptoms within a period of 24 hours. ResultsPain relief from severe or moderate to mild or none was obtained in 53.3% of subjects in the iVPA arm and 23.3% in the metoclopramide + sumatriptan arm at 1 hour following treatment (P = .033), whereas 60% and 30% reported pain relief at 2 hour (P = .037). There was no other significant difference in alleviation of associated migraine symptoms between the 2 arms. No serious adverse effects were noted. ConclusionTreatment with iVPA was more effective than metoclopramide + SQ sumatriptan during the first 2 hours in patients with a prolonged migraine.

Phaeochromocytoma crisis presenting with profound hypoglycaemia and subsequent hypertension

A patient was presented with four days of vomiting, abdominal pain and sweating. At presentation the Capillary Blood Glucose (CBG) was 1.7 mmol/L, the Blood Pressure (BP) was 182/102 mmHg, and the pulse 100 bpm. On examination, he was sweaty, pale and cold. The initial differential diagnosis was hypoglycaemia secondary to insulin abuse, hypoadrenalism or insulinoma, the transient hypertension being considered a consequence of sympathetic stimulation. He remained clinically well overnight with a CBG of 10-14 mmol/L following intravenous glucose. The next morning he complained of nausea and abdominal pain. The BP had risen to 203/127 mmHg when he was later reviewed, having been given 10mg intramuscular metoclopramide. Shortly afterwards, he developed acute pulmonary oedema and had become hypoglycaemic again; a phaeochromocytoma crisis was suspected. Treatment with alpha-adrenoceptor blockade with intravenous phenoxybenzamine was advised. However, the patient deteriorated and died in the Intensive Care Unit within two hours. Autopsy examination confirmed a phaeochromocytoma in the left adrenal, with haemorrhage within the head of pancreas, but no evidence of a pancreatic tumour.

Laparoscopic anterior gastropexy for chronic recurrent gastric volvulus: a case report

IntroductionGastric volvulus is an uncommon clinical entity, first described by Berti in 1866. It is a rotation of all or part of the stomach through more than 180°. This rotation can occur on the longitudinal (organo-axial) or transverse (mesentero-axial) axis. This condition can lead to a closed-loop obstruction or strangulation. Traditional surgical therapy for gastric volvulus is based on an open approach. Here we report the case of a patient with chronic intermittent gastric volvulus who underwent a successful laparoscopic treatment.Case presentationA 34-year-old woman presented with multiple episodes of recurrent upper abdominal pain associated with retching and vomiting, treated unsuccessfully with intramuscular metoclopramide. Endoscopic examination of the upper digestive tract showed a suspected rotation of the stomach, and a chronic recurrent gastric volvulus was revealed by barium meal. The patient was operated on successfully, with an anterior laparoscopic gastropexy performed as the first surgical approach.ConclusionExperience with laparoscopic anterior gastropexy is limited only to a few described cases. Our patient was clinically and radiologically followed-up for 2 years with no evidence of recurrence, either radiological or symptomatic. Based on this result, laparoscopic gastropexy can be seen and considered as an initial 'gold standard' for the treatment of gastric volvulus.

Clinical impact of a newly developed capsule endoscope: usefulness of a real-time image viewer for gastric transit abnormality

A new capsule endoscope has been developed by Olympus Medical Systems. The visualization and usefulness of its real-time image viewer for gastric transit abnormality were evaluated by using this new device. Thirty-seven consecutive patients were enrolled. In cases of gastric transit abnormality (gastric transit > 60 min, detected by the real-time viewer), intramuscular metoclopramide (10 mg) was administered. Diagnostic yield and gastric and small bowel transit times in ten patients receiving (group A) and 27 not receiving (group B) metoclopramide were analyzed. Median gastric transit time was longer in group A than in group B (110 vs. 24 min; P < 0.0001). Conversely, median small bowel transit time was shorter in group A than in group B (270 vs. 347 min; P < 0.05). Further, small bowel transit was complete in 9/10 patients (90%) in group A, and in 23/27 patients (85%) in group B, but the difference was not significant. Overall diagnostic yield was 78% (29/37 patients), and there was no significant difference in the ratio of abnormal findings documented between group A (8/10, 80%) and group B (21/27, 78%) patients. This new technology allowed clear image interpretation, and the real-time viewer was useful for detecting gastric transit abnormalities and determining a need for metoclopramide administration in patients undergoing capsule endoscopy.

A novel mutation in GCH-1 gene in a case of dopa-responsive dystonia

Sirs: Dopa-responsive dystonia (DRD) is an autosomal dominant disorder characterized by earlyonset dystonia, diurnal fluctuations with worsening toward the evening and after exercise, and sustained response to small doses of L-dopa without side effects [1]. DRD has incomplete penetrance and high variability of phenotipic expression. Females are affected two to four times more often than males [2]. Linkage analysis mapped the DRD locus on the chromosome 14q11-4.3 [3] and mutations in the GTP cyclohydrolase I gene (GCH-1) have been found in about 50% of cases [2]. GCH-1 is the rate-limiting enzyme in the synthesis of tetrahydrobyopterin (BH4) from GTP. BH4 is an essential cofactor for tyrosine-hydroxilase to convert Ldopa to dopamine. A 11-year-old girl presented an acute right hemidystonia after one intramuscular administration of 10 mg of metoclopramide. The antiemetic treatment was withdrawn and the symptomatology disappeared spontaneously after one day from the drug discontinuation. After one year she developed walking difficulties, stiffness, cramps, and abnormal posturing in the right arm. Symptoms improved after the nocturnal sleep and worsened toward the afternoon and after exercise. Her disturbance was first related to orthopedic postural abnormalities and later to a conversion disorder. At the age of 14 years she was admitted to our department. Her motor and development milestones had been normal and medical history was unremarkable. Her parents and sister were asymptomatic (Fig. 1A). Neurological examination showed dystonia at right arm and both legs. Unified Dystonia Rating Scale (UDRS) score was 15/112. The patient also presented scoliosis and bilateral pes cavus. Ceruloplasmine, anti-nuclear antibodies, thyroid function, and MRI brain were normal. Neurological examinations of her parents and sister were normal. A pharmacological test with 100 mg of L-dopa plus 25 mg of benserazide resulted in a dramatic improvement of all symptoms of the patient. After two years, she is still on a daily L-dopa treatment, at the same dosage with constant benefit and without side effects. Oral loading with 100 mg/kg of phenylalanine was performed as previously described [4]. Phe/Tyr ratios at 1, 2, 3, and 4 hours from capillary blood samples were outside the normal range, confirming a GCH1 activity decrease. The molecular study revealed a novel missense mutation within the GCH-1 gene at position c.630C > G (Fig. 1B). This mutation, which causes an amino acid change from histidine to glutamine (H210Q) in exon 6, was carried in heterozygosis by the proband and her mother, and it was not found in 100 normal chromosomes. The residue mutated in our patient is located in the enzyme active site that appears to be essential for the catalysis [5, 6] and is conserved among species from human to yeast. As a matter of fact, in the proposed reaction mechanism of the GCH-1, Histidine 210 assists the catalysis acting as a proton donor to a reaction intermediate. Given the different acid-base properties of a glutamine residue, the H210Q substitution certainly abolishes the enzymatic activity, as clearly shown by biochemical studies on GCH-1 mutants of the active site (Fig. 1C) [6, 7]. In our patient, the first dystonic manifestation followed intramuscular metoclopramide administration. Dystonic reactions due to metoclopramide, in absence of a dose-effect correlation, are known, especially in teenager girls [8]. In our patient, the antidopaminergic effect of the drug probably preA. De Rosa AE E. Xhoxhi AE C. Criscuolo S. Striano AE A. Filla AE G. De Michele (&) Dept. of Neurological Sciences Federico II University Via Pansini 5 80131 Naples, Italy Tel.: +39-081/7463711 Fax: +39-081/5469861 E-Mail demichel@unina.it

Metoclopramide for migration of naso-enteral tube.

Enteral alimentation by feeding tube is a common problem and an efficient method of providing nutritional support to hospitalized patients with insufficient oral intake, but adequate gastrointestinal function. The use of metoclopramide, a prokinetic agent, has been recommended to achieve transpyloric placement, but its efficacy is controversial. To determine the effect of intravenous metoclopramide on transpyloric passage of the naso-enteral tube. Relevant RCTs were identified by electronic search through MEDLINE, EMBASE, LILACS and the Cochrane Controlled Trials Register databases. Adults needing enteral nutrition. Types of intervention: Intravenous or intramuscular metoclopramide compared to placebo or no intervention. Types of studies: Randomised controlled trials. Types of outcome measures: The success of migration of transpyloric intubation. The reviewers evaluated the allocation concealment, which was classified as adequate, uncertain or inadequate. Two reviewers extracted the data independently. All analyses were performed according to the intention-to-treat method. Four studies were included and analysed. There was no statistically significant difference between intravenous or intramuscular metoclopramide administered to promote the tube migration (OR 0.65, 95% CI 0.33 to 1.28). Intravenous metoclopramide 10 mg (OR 0.68, 95% CI 0.37 to 1.23) and 20 mg (OR 0.27, 95% CI 0.01 to 10.84) were equally ineffective in facilitating transpyloric intubation. Four studies were included and analysed. There was no statistically significant difference between intravenous or intramuscular metoclopramide administered to promote the tube migration (OR 0.65, 95% CI 0.33 to 1.28). Intravenous metoclopramide 10 mg (OR 0.68, 95% CI 0.37 to 1.23) and 20 mg (OR 0.27, 95% CI 0.01 to 10.84) were equally ineffective in facilitating transpyloric intubation.

Intranasal metoclopramide.

Intranasal metoclopramide is a new formulation of an established and effective antiemetic drug. Absorption after intranasal administration was lower than after oral or intravenous administration; otherwise the pharmacodynamic and pharmacokinetic profiles of the intranasal and parenteral formulations were similar. Intranasal and intramuscular metoclopramide showed similar efficacy in the control of acute emesis induced by moderately emetogenic chemotherapy in 12 patients. Intranasal metoclopramide 80mg significantly reduced the frequency of acute vomiting in 43 patients receiving highly emetogenic chemotherapy. A pilot study suggested that intranasal metoclopramide, with or without dexamethasone, may reduce cisplatin-induced delayed emesis. In a randomised crossover trial in 40 patients, intranasal metoclopramide or oral metoclopramide, both with dexamethasone, were equally effective in the control of delayed emesis induced by moderately-emetogenic chemotherapy. One 30 patient study suggests that intranasal metoclopramide has similar efficacy to oral metoclopramide in the treatment of functional dyspepsia. A non-significant trend to reducing postoperative nausea and vomiting has been seen in two trials of intranasal metoclopramide. Intranasal metoclopramide caused minor irritation of the nasal membrane and unpleasant taste in some patients, but was otherwise well tolerated. None of the more serious extrapyramidal effects sometimes associated with metoclopramide were reported.

Prevalence of impaired gastric emptying of solids in systemic sclerosis: Diagnostic and therapeutic implications

The aims of this study were to evaluate the gastric emptying of solids in patients with progressive systemic sclerosis, correlate the esophageal motility abnormalities with their gastric emptying status, delineate the symptoms suggestive of abnormal gastric emptying, and assess the effect of metoclopramide in patients with abnormally slow gastric emptying. Twenty patients underwent esophageal motility evaluation and gastric emptying studies with a radiolabeled solid meal. Gastric emptying was also measured in 13 healthy volunteers. Four patients in whom esophageal motility was normal also had an accompanying normal rate of gastric emptying. In 16 patients with abnormal esophageal motility, mean gastric emptying was significantly delayed as compared with that in normal subjects (67.4% vs 49.8% retention of isotope at 2 hours, P < .05). Ten patients had absolute criteria for slow gastric emptying (>+2 SD). However, only postprandial bloating and early satiety were symptoms that accurately predicted slow radionuclide emptying. In four of these patients in whom gastric emptying was slow, 10 mg intramuscular metoclopramide significantly ( P < .05 vs baseline) accelerated the gastric emptying of the same test meal. We conclude that (1) gastric emptying of solids was delayed in approximately two thirds of patients with abnormal esophageal motility, whereas it was normal in patients with normal esophageal motor function; (2) metoclopramide significantly accelerated this slow gastric emptying; and (3) delayed gastric emptying contributes to the severity of the gastroesophageal reflux frequently present in patients with progressive systemic sclerosis, and promotility agents offer a valuable therapeutic approach.

How was it for you?

I have been on the receiving end of questions such as “How does it feel to be on the receiving end?” and “You don't need any help do you?” for much of this past year. The reason? A common condition, experienced by hundreds of thousands of women every year: pregnancy. Friends and colleagues were amused by my condition because I am a lecturer in obstetrics and gynaecology. Well, to those who asked, but especially to those who did not, let me tell you how I found this experience. Within days of me confirming my pregnancy, early morning sickness arrived. Well actually, all day and night nausea, and frequent vomiting. “This is a common condition, which usually resolves around 12 to 14 weeks,” states literature widely available to the newly pregnant. I tried acupressure bands, which made my wrists hurt but reduced the metallic taste in my mouth; ginger, which made no difference at all to my symptoms; and once, having been sick five times in an hour while doing an antenatal clinic, intramuscular metoclopramide. The problem was what to eat and drink. Strawberry flavoured milk shakes and chicken breasts became staple foods until around 18 weeks, when the vomiting ceased. I had a new problem then. I had decided, with my husband, that I should have an …

Definition of a gastric emptying abnormality in patients with anorexia nervosa.

Upper gastrointestinal symptoms may be prominent in anorexia nervosa. This study is an investigation of the gastric emptying of solid and liquid meal components in 16 female patients (mean age 20.0 years, range 14-40 years) who met accepted psychiatric diagnostic criteria for anorexia nervosa. The results were compared with those of gastric emptying studies in 10 normal females of ideal body weight (mean age 25.4 years, range 20-35), 13 normal persons (12 males), and six patients (mean age 12 years, range 9-14 years) with weight loss (less than 90 percent ideal body weight) secondary to Crohn's disease with no psychiatric symptoms. A dual-isotope technique using chicken liver intracellularly labeled with technetium-99m (99mTc) bound to sulfur colloid as the solid-phase marker, and indium-111 (111In) -labeled water as the liquid-phase marker was used. Gastric emptying was monitored for 2 hr by gamma camera. In 13 of the 16 anorexia nervosa patients (80%), gastric emptying of solids was slower than the range in the two groups of normal subjects, and mean gastric emptying was significantly slower (P less than 0.05) than in the weight-loss patients. Liquid emptying (water) in anorexia nervosa was normal and similar to the control groups studied. In 11 of the anorexia nervosa patients with delayed gastric emptying, intramuscular metoclopramide, 10 mg, significantly (P less than 0.05) accelerated the mean gastric emptying from 60 through 120 min after the meal. We conclude that in anorexia nervosa patients who are symptomatic and seeking medical care: gastric emptying of solids is significantly delayed when compared with female subjects of similar age and normal body weight and with patients of less than 90% ideal body weight but without psychiatric disorder; these data are consistent with an antral motility disturbance, either primary or secondary; and metoclopramide, a gastric prokinetic agent, accelerates (delayed) gastric emptying.

Pethidine, atropine, metoclopramide and the lower oesophageal sphincter.

The effects of an intramuscular injection of pethidine (1.5 mg/kg) plus atropine 0.5 mg, or pethidine (1.5 mg/kg) plus atropine 0.5 mg plus metoclopramide 10 mg on the lower oesophageal sphincter pressure have been studied manometrically in human volunteers. The mean barrier pressure in the former group was significantly lower than the baseline for the 75 minutes studied. In the latter group the mean barrier pressure was significantly lower than the baseline value for the first 45 minutes only of the study. The addition of atropine 0.5 mg to pethidine 1.5 mg/kg further lowers the barrier pressure when compared with the depression seen with pethidine alone in a previous study. While the addition of intramuscular metoclopramide to the mixture of pethidine and atropine fails to return the mean barrier pressure to the baseline value, it does raise the mean barrier pressure to a level which is probably above the opening pressure of the lower oesophageal sphincter.

Aspirin treatment of migraine attacks: plasma drug level data.

Plasma aspirin and salicylate levels were measured at intervals over a two hour period during migraine attacks in 10 subjects given 900 mg oral aspirin alone, in 10 subjects given 900 mg oral aspirin plus 10 mg oral metoclopramide, and in 10 subjects given 900 mg oral aspirin plus an intramuscular injection of 10 mg metoclopramide. Higher peak aspirin and salicylate levels occurred in patients given aspirin with metoclopramide. Aspirin tended to appear in plasma earlier in patients given aspirin with oral metoclopramide than in patients given aspirin alone, or aspirin with intramuscular metoclopramide. Patients given aspirin with oral metoclopramide tended to obtain better early pain relief than the other two treatment groups, though by one hour from dosage use of injected metoclopramide was also associated with better pain relief.

THE INFLUENCE OF THIETHYLPERAZINE ON THE ABSORPTION OF EFFERVESCENT ASPIRIN IN MIGRAINE

The absorption of effervescent aspirin was studied in three groups of patients during attacks of migraine. The first group received intramuscular thiethylperazine 10 min before effervescent aspirin; the second group received intramuscular metoclopramide 10 min before effervescent aspirin; and the third group received effervescent aspirin alone. Where possible each patient was retested when headache-free but under conditions which were otherwise as similar as possible to those during the acute attack. Intramuscular metoclopramide corrected the impairment of drug absorption that occurred during a migraine attack, whereas thiethylperazine did not. In the group of patients treated with thiethylperazine and aspirin, the impairment of absorption did not correlate with the duration of the symptoms, nor with the severity of the headache and nausea. Patients treated with thiethylperazine and aspirin tended to take longer to recover than those patients treated with metoclopramide and aspirin. However, in the thiethylperazine treated group, the time to recover did not correlate with the salicylate level achieved.