Mg Of Metoclopramide Research Articles

Comparative Efficacy of Magnesium Sulphate and Dexamethasone/Metoclopramide in the Treatment of Acute Migraine Headaches

Background: Migraine, a neurological condition characterized by intense and debilitating headaches, poses a significant public health issue affecting millions worldwide. The complexity of migraine pathophysiology often makes its management challenging. Despite various treatment modalities, the quest for the most effective and rapid relief from acute migraine episodes remains a pertinent concern in clinical practice. Objective: This study aimed to compare the efficacy of magnesium sulfate and a combination of dexamethasone/metoclopramide in treating acute migraine headaches to identify the most effective treatment option for rapid pain relief. Methods: This randomized controlled trial was conducted at the Department of Emergency Medicine, Benazir Bhutto Hospital, Rawalpindi, over six months from November 25, 2015, to May 24, 2016. A total of 70 patients were enrolled, with 35 patients assigned to Group A and 35 to Group B. Group A received 1g of magnesium sulfate in 100ml normal saline over 15 minutes, while Group B received 8mg of dexamethasone and 10mg of metoclopramide in a similar saline solution and infusion time. Pain severity was assessed using the Numeric Rating Scale (NRS) at baseline and two hours after medication administration. Data were analyzed using SPSS Version 25, with mean ± standard deviation calculated for age and NRS scores. Frequency and percentages were computed for gender and efficacy. Efficacy between the groups was compared using Chi-square tests, and stratification was applied to control for age and gender, followed by post-stratification Chi-square testing. A p-value of ≤ 0.05 was considered statistically significant. Results: The results showed a significant difference in pain relief between the two groups. In Group A, 23 patients (65.7%) reported significant pain relief compared to 13 patients (34.3%) in Group B (p=0.017). Stratification by age revealed that in patients under 30 years, 11 patients (31.4%) in Group A experienced pain relief compared to 8 patients (22.9%) in Group B (p=0.202). For patients over 30 years, 12 patients (34.3%) in Group A reported pain relief, compared to 5 patients (14.3%) in Group B (p=0.084). Gender stratification showed that among males, 5 (14.3%) in Group A experienced pain relief compared to 9 (25.7%) in Group B (p=0.408), while among females, 18 (51.4%) in Group A reported pain relief compared to 4 (11.4%) in Group B (p=0.000). Conclusion: Magnesium sulfate was found to be a more effective and faster-acting medication compared to a combination of dexamethasone and metoclopramide for the treatment of acute migraine headaches. This finding highlights the potential of magnesium sulfate as a preferred option for rapid pain relief in clinical settings, particularly for female patients.

The effect of different doses of neostigmine plus metoclopramide on the gastric residual volume in patients under enteral nutrition in intensive care unit

Background & Objective: Gastric motility disorder is common in patients admitted to an intensive care unit (ICU), leading to increased morbidity and mortality. We investigated the effects of different doses of neostigmine in combination with metoclopramide on gastric residual volume (GRV) in ICU patients on enteral feeding.
 Methods: In this double-blind clinical trial, 144 patients hospitalized in the ICU who were under enteral nutrition through nasogastric (NGT) or orogastric (OG) tube were randomly allocated to four groups. In all four groups, 20 mg of metoclopramide was prescribed IV slowly within one minute. In groups A, B, and C, 1, 1.5, and 2 mg of neostigmine were injected IV, respectively. Group D received only 20 mg of metoclopramide. All patients were gavaged every 4 h with 300 ml. The patient's head was kept at a 45° angle. To determine GRV, aspiration was done through NG tube or OG tube before the start of infusion and then at 3, 6, 9, and 12 h after the end of infusion.
 Results: There was no significant difference between the studied groups in terms of demographic variables such as age, blood pressure, heart rate and BMI (P > 0.05). The average difference of SOFA and APACHE and laboratory factors between the groups was not significant. The results of the comparison of the marginal averages of the residual volume of the stomach at different hours of the day showed that the amount of the residual volume at all hours had a significant average difference with each other. The addition of different doses of neostigmine had a significant effect on the residual volume of the stomach after 3 and 6 h (P < 0.05). Meanwhile, a dose of 2.0 mg of neostigmine had the most of the change 3 h after administration.
 Conclusion: Administration of neostigmine in combination with metoclopramide in ICU patients on enteral feeding significantly reduces the residual volume of the stomach within 12 hours after the treatment.
 Abbreviations: APACHE- Acute Physiology And Chronic Health Evaluation; GRV - Gastric Residual Volume; NG – Nasogastric; OG - Orogastric; SOFA- Sequential Organ Failure Assessment; VAP - ventilator-associated pneumonia
 Key words: APACHE; Enteral Nutrition; ICU; Metoclopramide; Neostigmine; SOFA
 Citation: Moshari M, Tahmasebi Z, Dahi M, Vosoughian M, Dabir S, Madadi F, Tabashi S, Ariannik M, Khatiri MAK. The effect of different doses of neostigmine plus metoclopramide on the gastric residual volume in patients under enteral nutrition in intensive care unit. Anaesth. pain intensive care 2024;28(1):33-38.
 DOI: 10.35975/apic.v28i1.2378
 Received: August 06, 2023; Reviewed: September 11, 2023; Accepted: September 21, 2023

The Effect of Intravenous Metoclopramide on Pain, Nausea, Discomfort, and Ease of Insertion of Nasogastric Tube in Emergency Department: A Double-blind Randomized Clinical Trial

Background: Placement of nasogastric tube (NGT) is a routine procedure in the emergency departments, which can be uncomfortable, painful, and cause nausea. The aim of this study was to investigate the effect of intravenous metoclopramide on the ease of NGT insertion, as well as reduction of patients’ pain, nausea, and discomfort during NGT insertion in the emergency department.
 Methods: In this randomized, double-blind, placebo-controlled trial, 80 patients referred to Imam Khomeini Hospital, Mazandaran Province, Iran were enrolled. Data were collected from December 2015 to March 2016. Participants were selected via convenience sampling and randomly divided into two equal groups (placebo and intervention groups). In metoclopramide and placebo groups, 10 mg of metoclopramide and 10 mg of normal saline solution were administered, respectively. All of the NGT was inserted 15–20 mins after the intravenous infusion. Patient-reported pain, discomfort, and nausea were evaluated using visual analogue scale (VAS), at four time points including before (T0), immediately (T1), 30 min after (T2), and 1 hr after the NGT placement (T3). The ease of NGT insertion was evaluated as easy, moderate, and difficult to pass.
 Results: None of the patients had pain, nausea, and discomfort in T0. Additionally, for those who received intravenous metoclopramide, pain intensity significantly decreased compared with the placebo group in T1 (37.7 vs 55.0), T2 (26.2 vs 41.7), and T3 (20.5 vs 33.7), respectively (P < 0.001). Nausea intensity decreased significantly over time among patients in the intervention group compared with the placebo group in T1 (32.7 vs 43.2), T2 (19.5 vs 31.2), and T3 (9.0 vs 21.7), respectively (P < 0.001). The intensity of patients’ discomfort decreased significantly among patients in the intervention group compared with the placebo group in T1 (39.5 vs 54.0), T2 (28.7 vs 40.2), and T3 (26.2 vs 39.6), respectively (P < 0.001). Patients in the intervention group had easier placement of NGT compared with the placebo group (Easy: 40.0% vs 0.0%, Moderate: 45.0% vs 62.5%, and Difficult: 15.0% vs 37.5%; P < 0.001).
 Conclusion: Based on the results of the present study, it seems that intravenous metoclopramide can be used as a promising modality for improving the ease of NGT placement and reducing patients’ pain, nausea, and discomfort during NGT insertion in the emergency department.

Efficacy and Safety of Enteral Erythromycin Estolate in Combination With Intravenous Metoclopramide vs Intravenous Metoclopramide Monotherapy in Mechanically Ventilated Patients With Enteral Feeding Intolerance: A Randomized, Double-Blind, Controlled Pilot Study.

In this pilot study, we aimed to determine the efficacy and safety of enteral erythromycin estolate in combination with intravenous metoclopramide compared to intravenous metoclopramide monotherapy in mechanically ventilated patients with enteral feeding intolerance. This randomized, double-blind, controlled pilot study included 35 mechanically ventilated patients with feeding intolerance who were randomly assigned to receive 10-mg metoclopramide intravenously every 6-8 hours in combination with 250-mg enteral erythromycin estolate (study group) or placebo every 6 hours for 7 days. The primary outcome was an administered-to-target energy ratio of ≥80% at 48 hours, indicating a successful feeding. Secondary, prespecified outcomes were daily average gastric residual volume (GRV), total energy intake, administered-to-target energy ratio, hospital length of stay, in-hospital mortality, and 28-day mortality. The rate of successful feeding was not significantly different between the study and placebo groups (47.1% and 61.1%, respectively; P = .51). The average daily GRV was significantly lower in the study group than in the placebo group (β = 91.58 [95% Wald CI, -164.35 to -18.8]), determined by generalized estimating equation. Other secondary outcomes were comparable, and the incidence of adverse events was not significantly different between the 2 groups. One common complication was cardiac arrhythmia, which was mostly self-terminated. Although the combination therapy of enteral erythromycin estolate and intravenous metoclopramide reduced GRV, the successful feeding rate and other patient-specific outcomes did not improve in mechanically ventilated patients with feeding intolerance.

SUN-924 Functioning Abdominal Paraganglioma Presenting as Acute ST-Elevation Myocardial Infarction

Background:Functioning paraganglioma is a rare catecholamine-producing tumor that arises in the sympathetic nervous system. It usually presents with sustained or paroxysmal hypertension accompanied by episodes of its classic triad of headache, palpitation, and diaphoresis. However, a wide range of signs and symptoms may be present. We report an unusual manifestation as acute myocardial infarction, which accidentally diagnosed by the trigger response from metoclopramide injection.Case presentationA 66-year-old woman with medical history of well-control hypertension, dyslipidemia and type 2 diabetes mellitus for 8 years presented with typical angina pain for 1 hour. She denied history of chest pain or triad symptoms of pheochromocytoma/paraganglioma (PCC/PGL). Her physical examination was unremarkable except severe hypertension, 206/89 mmHg, and occasional sinus tachycardia. Acute inferior wall myocardial infarction was proposed by an electrocardiogram study, acute ST elevation in lead II, III and aVF, and highly elevated cardiac enzymes. Echocardiogram and coronary angiography showed preserved left ventricle function (LV ejection fraction 70%) without regional wall motion abnormality. No evidence of coronary artery disease was found. During the catheterization, the cardiologist raised the possibility of the presence of PCC/PGL from her fluctuating blood pressure, 73/42 to 206/113 mmHg, after 10-mg metoclopramide injection to control her vomiting. Computer tomography of the abdomen showed a lobulated heterogeneous enhancing left para-aortic mass with internal necrosis, 6.1x4.9x4.1 cm in size, abutting left anterolateral aortic wall and encasing celiac trunk, superior mesenteric artery, and left renal arterial wall. Her hormonal study showed 24-hour urine fractionated metanephrine/normetanephrine levels of 2,924 nmol (<1,777 nmol)/4,328 nmoL(< 3,279 nmol), respectively, and plasma free metanephrine/normetanephrine levels of 93.66 pg/mL (0-96.6 pg/mL)/233.61 pg/mL (0-163.05 pg/mL). She underwent surgical tumor removal with uneventful outcome and the pathology confirmed the diagnosis of functioning PGL. During 2-years follow-up, the patient remained asymptomatic and her hormonal and functioning imaging study showed no recurrence. The genetic testing for PCC/PGL panel was negative.Conclusion:We present an unusual manifestation of PCC/PGL as acute coronary syndrome. The clinician should remind this tumor as the differential diagnosis, especially in a patient with negative coronary angiogram.

The effect of ginger and metoclopramide in the prevention of nausea and vomiting during and after surgery in cesarean section under spinal anesthesia.

ObjectivePostoperative nausea and vomiting is one of the most common side effects after anesthesia in surgeries, such as cesarean section. This study aimed to investigate the effect of ginger and metoclopramide in the prevention of nausea and vomiting during and after cesarean section.MethodsThis clinical trial was conducted on 180 patients aged 18–40 years who underwent cesarean section under spinal anesthesia. The first group received 10 mg of metoclopramide via intravenous injection (metoclopramide group), and the second group received 1 g of oral ginger (ginger group) half an hour before spinal anesthesia. The frequency and severity of nausea and vomiting during surgery and at 2, 6, 12, and 24 hours postoperatively were compared in both groups. To analyze the results, the t-test, chi-square test, and Mann-Whitney test were used.ResultsThere was no significant difference in the frequency of nausea and vomiting between the 2 groups during operation, 2 hours and 6 hours after surgery (P=0.182, 0.444 and 0.563 respectively). The severity of nausea and vomiting was also similar in the 2 groups (P=0.487 and 0.652 respectively); however, the metoclopramide group had a lower systolic blood pressure (P<0.001; df=2.176; f=18.66) and mean arterial pressure (P<0.001; df=2.176; f=6.36) than the ginger group.ConclusionThe results revealed that ginger reduced nausea and vomiting to the same extent as metoclopramide in patients undergoing cesarean section.Trial RegistrationIranian Center for Clinical Trials Identifier: IRCT201611028611N3

Auscultation-assisted bedside postpyloric placement of feeding tube in critically ill patients: a prospective, observational study.

To assess the efficacy and safety of auscultation-assisted bedside postpyloric feeding tube (ABPFT) placement in early enteral nutritional support for critically ill patients. A prospective observational study was conducted and 92 critically ill patients who met the inclusion criteria undergoing ABPFT placement after the intravenous injection of 10 mg of metoclopramide were included. Abdominal X-ray was performed to confirm the location of the catheter tip. End points investigated were the success rate of tube placement, rate of jejunal tube placement, duration of the procedure, length of insertion, and number of attempts. Operational-related adverse events or complications were also documented and evaluated. The total success rate of postpyloric feeding tube implantation was 97.8% (90/92), among which, 89.1% (82/92) of the tubes were placed proximal to the jejunum. The first-attempt success rate was 91.3% (84/92) and the mean attempt per individual patient was 1.11±0.38 times. The mean operation time was 28.6±17.7 minutes, and the mean insertion length of tube was 106±9.6 cm. A total of 27 adverse events occurred in 19.6% (18/92) patients and there was no serious adverse events or complications during the study period. Assistance by auscultation can significantly improve the success rate of nasal feeding tube placement. This simple, safe and fast approach is feasible for the application among health practitioners in the intensive care unit.

The Effect of Metoclopramide on Prolactin Levels in Breastfeeding Mothers: A Systematic Review and Meta-Analysis

Background: Exclusive breastfeeding is beneficial to not only infants, but also mothers. Since prolactin stimulates milk production, increasing its levels through dopamine antagonists, such as metoclopramide, may enhance milk production. However, the efficacy of this method should be further studied. Therefore, this systematic review sought to determine the effects of metoclopramide on prolactin levels in breastfeeding mothers. Materials and Methods: In this systematic review study, International and National data bases such as PubMed,Google Scholar, Cochrane Library, Scopus, Web of Sciences, SID,Magiran, and Iranmedexwere searched for the keywords of lactation, breastfeeding, prolactin, metoclopramide and breast milk. Articles published during 1979 to 2016 in either English or Persian was selected. The review was limited to human clinical trials examining the effects of metoclopramide on mothers’ serum prolactin levels. Two authors independently evaluated the eligibility the studies and cases of disagreement were resolved through consensus. Results: Five studies on the effects of metoclopramide on mothers’ serum prolactin levels were included in this systematic review. Based on their results, compared to placebo, two weeks of metoclopramide administration did not have significant effects on mothers’ serum prolactin levels (mean difference: 73.06; 95% confidence interval [CI]:-19.99 to 166.11) However, placebo-controlled studies showed significant changes in prolactin levels after using metoclopramide for three weeks (mean difference: 111.06; 95% CI: 1.93 to 220.20). Conclusion: The result of meta-analysis showed that the use of 10 mg of metoclopramide three times a day for three weeks increased mothers’ serum prolactin levels after childbirth.

58 Measuring pyloric function using the functional lumen imaging probe

Background Manometric studies are known to be inadequate in evaluating tone and opening patterns of digestive sphincters. The functional lumen imaging probe (FLIP) evolved as an important tool in evaluating sphincteric regions in the gastrointestinal tract. Aim To evaluate the potential for this technique in a pilot study on a human volunteer to 1. Evaluate the efficiency and efficacy of placing and measuring with the probe endoscopically. 2. Demonstrate if the shape and function of the pylorus could be measured using this device. 3. Evaluate the effect of the administration of a pro-kenetic drug on the function of the pylorus. Method One subject volunteered for the procedure as the probe is already approved for diagnostic use in the gastrointestinal tract. The EndoFLIP system (Crospon, Galway, Ireland) was set up as previously described using probe model EF-353. An Olympus therapeutic endoscope was inserted as per normal upper gastrointestinal investigation. The probe was inserted into the endoscope biopsy channel and positioned straddling the pylorus. Distension measurements were made with probe volumes of 20 ml, 30 ml and 40 ml before and after the administration of 10 mg of metoclopramide (Primperan). Results Activity dramatically changed in the pylorus after Primperan. The narrowest region the sphincter measured using the minimum cross sectional (CSAmin) area was relatively inactive and stable before the drug but after the CSAmin varied significantly during the 20 s measurement window, indicating changes in activity. Conclusions The FLIP system can successfully measure distensibility in the pylorus and these measurements may be useful in determining proper function in the region.

Preoperative Use of 10-mg Metoclopramide and 50-mg Dimenhydrinate in the Prophylaxis of Postoperative Nausea and Vomiting in Elective Caesarean Births: A Prospective Randomized Clinical Study.

The purpose of this study was to assess the efficacy and outcomes of preoperative prophylactic metoclopramide and dimenhydrinate use in elective cesarean births. Participants (n=84) scheduled for elective cesarean births were randomized equally into placebo (10cc 0.9% NaCl), 10-mg metoclopramide or 50-mg dimenhydrinate groups. Oral alimentation was prohibited 8h before the surgery; however, patients continued drinking water until 4h before surgery. Placebo and antiemetics were administered 1h before the anticipated procedure in a 5-ml syringe. In metoclopramide and dimenhydrinate group, an ampoule of the agents was completed to 5ml by adding 0.9% NaCl. In the control group 5ml of 0.9% NaCl was used. All prophylactic agents were administered intramuscularly. All patients received a general anesthesia. The placebo group (control group) was compared with the metoclopramide and dimenhydrinate groups. Demographic data including maternal age, height, weight, body mass index, gravidity, parity, miscarriage, induced abortion, the number of offspring, and the medical history did not show significant differences among the three groups. Postoperative nausea, vomiting, and the use of rescue medication ratios were significantly lower in metoclopramide and dimenhydrinate groups compared with the placebo group (p<0.05); however, the difference between the metoclopramide and dimenhydrinate groups was not significant (p>0.05). Dimenhydrinate and metoclopramide significantly decrease postoperative nausea, vomiting, and the need for rescue antiemetic medication. Both agents have similar efficacy and may be used as an alternative to each other.

Metoclopramide for patients with intractable hiccups: a multicentre, randomised, controlled pilot study.

Limited data exist regarding the efficacy of metoclopramide in the treatment of intractable hiccups. This study aimed to assess the feasibility efficacy of metoclopramide in the treatment of patients with intractable hiccups. A total of 36 patients with intractable hiccups was randomly assigned to arm A (n = 18) or arm B (n = 18) in a multicentre, double-blind, randomised, controlled pilot study. Participants in arm A received 10-mg metoclopramide thrice daily for 15 days, whereas those assigned to arm B received 10-mg placebo thrice daily for 15 days. The primary outcome measure was total efficacy against hiccups (including cessation and improvement of hiccups). Secondary outcome measures included a comparison of overall efficacy and adverse events between the two arms. Of the 36 patients enrolled, 34 participants completed the study. The total efficacy was higher in arm A than in arm B (relative risk, 2.75; 95% confidence interval: 1.09-6.94, P = 0.03). Furthermore, comparison between the two arms revealed that overall efficacy was higher in arm A than that in arm B (P < 0.05). No serious adverse events related to the treatment were documented in either arm. The most common adverse events occurring in patients in arm A included fatigue, upset mood and dizziness. Metoclopramide appears to be a promising candidate for the treatment of patients with intractable hiccups, with mild adverse events. However, further clinical trials are required to confirm these results.

First clinical trial of a newly developed capsule endoscope with panoramic side view for small bowel: A pilot study

Capsule endoscopy is the first-line diagnostic technique for the small bowel. However, the inability to visualize the duodenal papilla is an inherent limitation of this method. In the present study, we evaluated feasibility of a newly developed CapsoCam SV1 capsule. This is a prospective dual center study of a newly developed video capsule CapsoCam SV1 from Capsovision, CA, providing panoramic 360° imaging. A high frequency of 20 frames occurs per second for the first 2 h and thereafter 12 frames/s, with a battery life of 15 h. We evaluated feasibility and completeness of small bowel examination together with secondary endpoints of duodenal papilla detection in 33 patients. Patients swallowed the capsules following colonoscopy or were prepared with 2 L of polyethylene glycol solution prior to the examination. All patients swallowed 20 mg of metoclopramide and 160 mg of simethicone 30 min before ingestion of the capsule. Thirty-one of the 33 patients' data could be evaluated. Small bowel examination was complete in all procedures. Mean time to pass the small bowel was 258 ± 136 min. Average small bowel cleanliness was 3.3 ± 0.5. In 71% of the patients, we identified the duodenal papilla. No adverse reaction in relation to the capsule examination was observed. CapsoCam SV1 is a safe and efficient tool in small bowel examination. The duodenal papilla as the only landmark in small bowel is detected in more than 70% of the patients.

Impact of metoclopramide on image quality in myocardial perfusion imaging

The effectiveness of metoclopramide in reducing gastrointestinal-induced artifacts in myocardial perfusion imaging (MPI) is a subject of debate. We examined the significance of this pharmacological intervention in the quality of images obtained from MPI studies. A total of 211 suspected or known cases with coronary artery disease routinely referred to our nuclear medicine department for MPI were randomly assigned to group A and group B. Group A (N=125) comprised patients who received 10 mg of metoclopramide orally after the injection of the radiotracer [technetium-99m-labeled methoxyisobutyl isonitril (99mTc-MIBI)] 1 h before image acquisition, and group B (N=86) comprised patients who did not receive any pharmacological intervention and were considered the control group. All the scans in each group were assessed in the rest phase of a routine 2-day protocol. The single-photon emission computerized tomography (SPECT) images were visually evaluated in terms of extracardiac activities and their effects on image quality by three nuclear medicine physicians, who were blinded to the details of the protocol. Of the 125 patients who had received metoclopramide, 16 (13%) had nonacceptable, 72 (57.6%) had acceptable (interpretable), and 37 (29.6%) had good image quality. The image quality in group B was nonacceptable in 10 (11.23%), acceptable in 48 (50.23%), and good in 28 (33.56%) patients. The overall interobserver agreement was good (κ: 0.6-0.9, P<0.05) among the three readers. There was no statistically significant difference in terms of MPI-SPECT image quality between patients who received metoclopramide and those in the control group. Metoclopramide, therefore, did not exert a remarkable effect on the quality of our MPI scans.

Tramadol-metoclopramide or remifentanil for patient-controlled analgesia during second trimester abortion: a double-blinded, randomized controlled trial

Study ObjectiveTo compare patient-controlled analgesia (PCA) with tramadol with PCA with remifentanil in second trimester abortion. DesignProspective, randomized double-blinded study SettingUniversity-affiliated medical center. Patients30 ASA physical status 1 and 2 patients undergoing a second trimester abortion. InterventionsPatients received PCA with either tramadol or remifentanil. Analgesia was initiated in the tramadol group by an initial loading dose of tramadol 1.0 mg/kg with 10 mg of metoclopramide followed by a PCA bolus of 0.3 mg/kg/mL of tramadol every 5 minutes. For remifentanil, which does not require a loading dose, a placebo of 100 mL of 0.9% normal saline was given followed by PCA of 0.4 μg/kg/mL every two minutes. MeasurementsWomen were evaluated for pain via verbal analog score (VAS; 0-100), sedation, nausea, blood pressure, pulse, and respiratory rate. On the day of discharge, women were analyzed for overall satisfaction. Primary outcome was pain scores and general satisfaction. Main ResultsAnalysis by time yielded no statistically significant difference in VAS scores between the groups at any point except 16-20 hours after induction of labor, when pain was lower in the tramadol group (11.3 ± 18.1 vs. 36.7 ± 27.4; P = 0.04). The average VAS score was low in both groups, with no significant differences noted between groups (P = 0.74). Satisfaction scores were high in both groups, with no significant differences noted between them (P = 0.89). ConclusionBoth drugs are acceptable choices for pain control in patients undergoing second trimester abortions.

Metoclopramide

Metoclopramide

Optimal Approach for Small Bowel Capsule Endoscopy Using Polyethylene Glycol and Metoclopramide with the Assistance of a Real-Time Viewer

Aim: Capsule endoscopy is limited by the poor image quality of the distal bowel and incomplete small bowel transit. The aim of this study was to establish an optimal medication protocol for capsule endoscopy performed using a real-time viewer. Methods: A total of 80 patients were prospectively recruited. The patients were randomized into two groups: the ‘conventional group’ (without any preparation) and the ‘real-time group’ (in which a real-time viewer was attached). At 60 min after swallowing the capsule, if the capsule hadreached the small bowel, 500 ml of polyethylene glycol was administered; if the capsule was still located in the stomach, 10 mg of metoclopramide was given intramuscularly, followed by 500 ml of polyethylene glycol solution. Results: The completion rate was significantly higher in the real-time group as compared with that in the conventional group (72.5 vs. 90.0%). Our protocol yielded a significantly improved image quality of the distal small bowel [image quality score = 1.6 vs. 3.0 (max 4.0)]. The detection rate of lesions in the distal small bowel was higher in the real-time group than in the conventional group. Conclusions: The present study clearly showed that our protocol yielded an improved completion rate and also improved image quality.

Mo1541 SV1: A Newly Developed Small Bowel Capsule Endoscope With Panoramic Imaging and Improved Detection of the Duodenal Papilla

Capsule endoscopy has evolved to become a first-line, noninvasive diagnostic technique for the small bowel. However, the inability to visualize the duodenal papilla is an inherent limitation of this method. We evaluated the diagnostic yield and completeness of the small bowel examination with a newly developed video capsule (SV1, Capsovision, Saratoga, CA) with panoramic imaging. SV1 is a newly developed small bowel video endoscope measuring 11 × 31 mm capturing colour high-resolution images at 4 frames per second in a 360-degree-panorama-view for the first 2 hours and 3fps for the rest of time. This enables a side view like with ERCP. A motion detector allows the video capsule to take photographs more frequently when the video capsule is moving more rapidly. The device does not employ wireless technology. SV1 saves the data on the on-board flash memory when it traverses through the bowel. The capsule is retrieved, opened by the docking station where the data are transferred by USB to the reviewing workstation. 19 patients (12 F and 7 M, mean age 42 y) in whom evaluation of the small bowel was indicated swallowed SV1 either after colonoscopy or after a preparation with 2 l of a PEG solution in the afternoon before the examination. The patients swallowed 20 mg of metoclopramide and 170 mg of simethicone 30 min before swallowing the capsule. They were allowed to eat after 6 hours. The capsules were retrieved in 17 of 19 patients forming the study population. The indication was Crohn's disease (after exclusion of stenoses) in 3, undefined chronic inflammatory disease in 1, NSAR use in 2, Anemia in 5, duodenal polyp after polypectomy in 1, chronic diarrhea in 2, tumor of unknown origin in 1, and unexplained abdominal discomfort in 2 patients. The mean time to pass the stomach was 26 min and the small bowel 243 min. The duodenal papilla was identified in 11 of 17 patients (65%). We further detected mucosal breaks/ulcers in 3 patients with Crohn's disease, in 1 patient with NSAR use and in 1 patient with anemia. No adverse effects were detected. Compared to capsules with cameras at the end, SV1 with a 360 degree imaging detects the duodenal papilla in a higher proportion which constitutes an advantage for the diagnosis of neoplasms of the papilla and duodenum. We also detected pathologic findings in the lower part of the small bowel. Every capsule reached the ileocecal valve. Small bowel capsule endoscopy with SV1 is a safe procedure. The panoramic imaging capsule seems to have an advantage in small bowel.

Mo1542 Virtual Chromoendoscopy With I-Scan Enables More Precise Diagnosis of Mucosal Inflammation in Patients With Inflammatory Bowel Disease

second in a 360-degree-panorama-view for the first 2 hours and 3fps for the rest of time. This enables a side view like with ERCP. A motion detector allows the video capsule to take photographs more frequently when the video capsule is moving more rapidly. The device does not employ wireless technology. SV1 saves the data on the on-board flash memory when it traverses through the bowel. The capsule is retrieved, opened by the docking station where the data are transferred by USB to the reviewing workstation. 19 patients (12 F and 7 M, mean age 42 y) in whom evaluation of the small bowel was indicated swallowed SV1 either after colonoscopy or after a preparation with 2 l of a PEG solution in the afternoon before the examination. The patients swallowed 20 mg of metoclopramide and 170 mg of simethicone 30 min before swallowing the capsule. They were allowed to eat after 6 hours. Results: The capsules were retrieved in 17 of 19 patients forming the study population. The indication was Crohn’s disease (after exclusion of stenoses) in 3, undefined chronic inflammatory disease in 1, NSAR use in 2, Anemia in 5, duodenal polyp after polypectomy in 1, chronic diarrhea in 2, tumor of unknown origin in 1, and unexplained abdominal discomfort in 2 patients. The mean time to pass the stomach was 26 min and the small bowel 243 min. The duodenal papilla was identified in 11 of 17 patients (65%). We further detected mucosal breaks/ulcers in 3 patients with Crohn’s disease, in 1 patient with NSAR use and in 1 patient with anemia. No adverse effects were detected. Discussion: Compared to capsules with cameras at the end, SV1 with a 360 degree imaging detects the duodenal papilla in a higher proportion which constitutes an advantage for the diagnosis of neoplasms of the papilla and duodenum. We also detected pathologic findings in the lower part of the small bowel. Every capsule reached the ileocecal valve. Small bowel capsule endoscopy with SV1 is a safe procedure. The panoramic imaging capsule seems to have an advantage in small bowel.

Metoclopramide to augment lactation, does it work? A randomized trial

Objectives. The objective of this study was to investigate the efficacy of metoclopramide on augmentation of milk production in mothers of premature newborns.Methods. This was a randomized, double-blind, placebo-controlled trial. Women who delivered at ≤34 weeks of gestation, with no prior breastfeeding experience, singleton pregnancy, and no contraindications to using metoclopramide were eligible for entry. Twenty-five women were randomly assigned to receive 10 mg of metoclopramide or placebo three times daily for 8 days starting within 36 h of birth. Certified lactation nurses provided breastfeeding education. Breast milk expressed at each pumping session over the 8 days of treatment was recorded.Results. Data from 18 patients were available for analysis. Milk production in both groups increased rapidly during the first 4 days and then more gradually to an average for the last 4 days of 633 ± 168 (9) ml/day [mean ± SEM (n)] for the placebo group and 459 ± 91 (10) ml/day for the metoclopramide group. Analysis with a repeated-measures ANOVA indicated a significant increase in milk production during the 8-day measurement period [within subjects p < 0.001]; however, there was no significant difference in milk production between the two groups [between subjects p = 0.427]. Side effects were similar between groups.Conclusion. In mothers with preterm babies, metoclopramide treatment does not augment (sample size had 80% power for detection of 50% difference) the breast milk production. Maternal interest, education, and support are recognized as mainstay in accomplishing successful lactation.

Metoclopramide for Acute Migraine: A Dose-Finding Randomized Clinical Trial

Intravenous metoclopramide is effective as primary therapy for acute migraine, but the optimal dose of this medication is not yet known. The objective of this study is to compare the efficacy and safety of 3 different doses of intravenous metoclopramide for the treatment of acute migraine. This was a randomized, double-blind, dose-finding study conducted on patients who presented to our emergency department (ED) meeting International Classification of Headache Disorders criteria for migraine without aura. We randomized patients to 10, 20, or 40 mg of intravenous metoclopramide. We coadministered diphenhydramine to all patients to prevent extrapyramidal adverse effects. The primary outcome was improvement in pain on an 11-point numeric rating scale at 1 hour. Secondary outcomes included sustained pain freedom at 48 hours and adverse effects. In this study, 356 patients were randomized. Baseline demographics and headache features were comparable among the groups. At 1 hour, those who received 10 mg of intravenous metoclopramide improved by a mean of 4.7 numeric rating scale points (95% confidence interval [CI] 4.2 to 5.2 points); those who received 20 mg improved by 4.9 points (95% CI 4.4 to 5.4 points), and those who received 40 mg improved by 5.3 points (95% CI 4.8 to 5.9 points). Rates of 48-hour sustained pain freedom in the 10-, 20-, and 40-mg groups were 16% (95% CI 10% to 24%), 20% (95% CI 14% to 28%), and 21% (95% CI 15% to 29%), respectively. The most commonly occurring adverse event was drowsiness, which impaired function in 17% (95% CI 13% to 21%) of the overall study population. Akathisia developed in 33 patients. Both drowsiness and akathisia were evenly distributed across the 3 arms of the study. One month later, no patient had developed tardive dyskinesia. Twenty milligrams or 40 mg of metoclopramide is no better for acute migraine than 10 mg of metoclopramide.