Motility Agents Research Articles

Reflux after oesophagectomy

Reflux of gastric and duodenal content after oesophagectomy with gastric conduit reconstruction is a common problem and largely considered an inevitable consequence of surgery. Cervical burning and regurgitation, often more pronounced when supine, can be troublesome and even disabling, interfering substantially with quality of life. The aim of this study was to identify the factors contributing to reflux after oesophagectomy and evaluate measures to prevent or control it. A Medline search using the terms 'gastro-oesophageal reflux', 'oesophagectomy' and 'antireflux surgery' was conducted. Additional references and search pathways were sourced from the bibliographies of articles located. Reflux after oesophagectomy is a significant problem, with both clinical and pathological consequences. Simple measures to facilitate gastric emptying, such as creating a gastric tube, performing a pyloric drainage procedure and using gastric motility agents, may produce a reduction in symptoms but do not alone control reflux itself. A variety of surgical reconstructions have been used, many of which are either difficult to fashion or not suitable when a radical resection has been performed. A modified fundoplication at the anastomosis seems to be the simplest technique and may be relatively effective in controlling symptoms. The impact of strategies to reduce reflux on quality of life and on pathological sequelae of reflux in the oesophageal remnant remains to be evaluated.

Effects of insulin-like growth factor-I on cultured human coronary artery smooth muscle cells.

The growth-promoting effects of insulin-like growth factor-I (IGF-I) appear to be different in vascular smooth muscle cells from various segments of the arterial tree. Little information exists on human coronary artery smooth muscle cells (CoSMC), the primary elements of coronary atherosclerosis and post-angioplasty restenosis. In this study we determined the effects of IGF-I on cultured human CoSMC. Type I IGF receptors (IGF-R) were present on CoSMC as assessed by affinity cross-linking of 125I-IGF-I to monolayer cultures. IGF-I was a weak mitogen, 1.5-fold increase in [3H]thymidine incorporation, for CoSMC. However, IGF-I had a potent motility effect on CoSMC with a 314+/-12% increase in cell migration (P<0.001), comparable to that of 5% FBS. IGF-I-stimulated motility was partially inhibited by alphaIR-3, a specific IGF-R inhibitor (P<0.05). Addition of kistrin, a disintegrin, or LM609, a specific alpha(V)beta(3) integrin neutralizing antibody, abolished IGF-I-stimulated migration (P<0.001). This study indicates that IGF-I is a potent motility agent for human CoSMC via the alpha(V)beta(3) integrin receptor, but exerts little mitogenic effect. Because CoSMC migration plays a crucial role in atherosclerosis and restenosis, IGF-I blockade has the potential to limit lumen reduction.

Anticholinergic suppression of fetal rabbit upper gastrointestinal motility

Objective: At birth the newborn digestive tract must assume the responsibility of assimilating nutrients for survival. Immature gastrointestinal motility in the neonate may result in impaired feeding and nutrition. Newborn gastrointestinal motility development requires the expression and functional maturation of gastrointestinal receptors. To explore the timing of fetal responses to gastrointestinal cholinergic motility agents, we assessed the effect of the anticholinergic agent atropine in the late-gestation rabbit fetus. Methods: Seven pregnant New Zealand White rabbits were studied at day 30 of their normal 31-day gestation. In each litter, two fetuses were selected as study (n = 14) and two as control (n = 14). Under ultrasound guidance, a spinal needle was percutaneously inserted through the maternal uterus into the fetal stomach and 0.5 ml of gastric content was aspirated. Fluorescein, labelled with colored microspheres, and either atropine (0.04 μg/g fetal body weight) or normal saline were injected in a total volume of 0.5 ml. Two hours after injection, fetuses were delivered, the small intestine harvested, and the total small intestinal length and the distance the gastrointestinal fluorescein travelled were measured by ultraviolet light optical density. The fluorescein travelled distance and the per cent motility, defined as the length of fluorescein travelled divided by the total length of the small intestine, were calculated. Results: All fetuses survived the intragastric injection. Mean fetal body weight at delivery was 44.2 ± 6.7 and 46.8 ± 7.2 g in atropine and control fetuses, respectively. The fluorescein travelled distance (15.4 ± 4.2 vs. 19.0 ± 4.3 cm;. p < 0.01) and per cent motility (51.0 ± 8.9 vs. 63.8 ± 11.7%; p < 0.01) of atropine-treated fetuses were significantly lower than those of control fetuses. Conclusion: Fetal upper gastrointestinal motility is suppressed in response to intragastric atropine. These results indicate that fetal gastrointestinal cholinergic receptors are expressed and functional in the term (0.97 gestation) rabbit fetus. In utero administration of cholinergic agonists/antagonists may potentially modulate fetal gastrointestinal motility and absorption of amniotic fluid water and solutes.

Anticholinergic suppression of fetal rabbit upper gastrointestinal motility

Objective: At birth the newborn digestive tract must assume the responsibility of assimilating nutrients for survival. Immature gastrointestinal motility in the neonate may result in impaired feedingand nutrition. Newborn gastrointestinal motility development requires the expression and functional maturation of gastrointestinal receptors. To explore the timing of fetal responses to gastrointestinalcholinergic motility agents, we assessed the effect of the anticholinergic agent atropine in the late-gestation rabbit fetus.Methods: Seven pregnant New Zealand White rabbits were studied atday 30 of their normal 31-day gestation. In each litter, two fetuses were selected as study (n = 14) and two as control (n = 14). Under ultrasound guidance, a spinal needle was percutaneouslyinserted through the maternal uterus into the fetal stomach and 0.5 ml of gastric content was aspirated. Fluorescein, labelled with colored microspheres, and either atropine (0.04 μg/g fetal body weight)or normal saline were injected in a total volume of 0.5 ml. Two hours after injection, fetuses were delivered, the small intestine harvested, and the total small intestinal length and the distance the gastrointestinalfluorescein travelled were measured by ultraviolet light optical density. The fluorescein travelled distance and the per cent motility, defined as the length of fluorescein travelled divided by the totallength of the small intestine, were calculated.Results: All fetuses survived the intragastric injection. Mean fetal body weight at delivery was 44.2 ± 6.7 and 46.8 ± 7.2 g in atropineand control fetuses, respectively. The fluorescein travelled distance (15.4 ± 4.2 vs. 19.0 ± 4.3 cm;. p < 0.01) and per cent motility (51.0 ± 8.9 vs. 63.8 ± 11.7%;p < 0.01) of atropine-treated fetuses were significantly lower than those of control fetuses.Conclusion: Fetal upper gastrointestinal motility is suppressed in response to intragastricatropine. These results indicate that fetal gastrointestinal cholinergic receptors are expressed and functional in the term (0.97 gestation) rabbit fetus. In utero administration of cholinergic agonists/antagonistsmay potentially modulate fetal gastrointestinal motility and absorption of amniotic fluid water and solutes.

Bedside placement of postpyloric feeding tubes.

Postpyloric placement of feeding tubes into the duodenum or jejunum is often recommended to support early feeding, improve tolerance of enteral nutrition, and decrease the risk of aspiration pneumonia. Achieving small bowel feeding tube placement can be a difficult, time-consuming, and costly process that may delay the initiation of enteral nutrition. Various bedside techniques, including air insufflation, pH assisted, and spontaneous passage with or without motility agents are available to facilitate transpyloric feeding tube passage. A discussion of these methods is presented in this article, including a hospital-based quality initiative project designed to facilitate early enteral nutrition.

Potato-lactulose breath hydrogen testing as a function of gastric motility in diabetes mellitus.

Scintigraphic determination of gastric emptying is the current standard for the assessment of gastric motility and the diagnosis of diabetic gastroparesis. However, such studies are expensive, inconvenient, and involve exposure to radiation. Because the time course of breath hydrogen (H2) excretion after ingestion of lactulose correlates with upper gastrointestinal transit time, we hypothesized that patients with diabetic gastroparesis would exhibit prolonged breath H2 excretion after ingestion of a test meal containing complex carbohydrate and lactulose compared to subjects without diabetes and subjects with diabetes but without gastroparesis. Ten healthy subjects without diabetes, 10 subjects with diabetes but without gastroparesis (gastric emptying T1/2,T1/2 < 90 minutes), and 10 subjects with diabetes and previously diagnosed gastroparesis (T1/2 > 90 minutes) were admitted for a single 24-hour study. Gastric motility agents were withheld 24 hours prior to the study. Euglycemia was established and maintained overnight in subjects with diabetes with continuous intravenous insulin infusion. At 6:00 AM, all subjects ingested a breakfast containing 100 g of cooked potato starch and 20 g lactulose. Breath H2 excretion was monitored at baseline and every 30 minutes for 12 hours after ingestion of the test meal. Twelve hours after ingestion of the test meal, raw and baseline adjusted breath H2 excretion was significantly elevated in the gastroparesis group compared to the unaffected group with diabetes and the group without diabetes (p < 0.001). The baseline and 12-hour data points were adequate to discriminate between normal and delayed gastric emptying. We conclude that patients with previously diagnosed gastroparesis exhibit prolonged breath H2 excretion after ingestion of a test meal. This test may prove to be a safe, reliable, and affordable outpatient screening test for diabetic gastroparesis.

Effect of Cisapride, Erythromycin, and Metoclopramide on Gastrointestinal Transit Time in the Desert Tortoise, Gopherus agassizii

ABSTRACT The desert tortoise, Gopherus agassizii, is a common pet in the southwestern United States and like other tortoise and reptile species, can suffer from gastrointestinal stasis in captivity. We gavaged captive desert tortoises daily with erythromycin (2 mg/kg), metoclopramide (1 mg/kg) or cisapride (1 mg/kg) and compared gastrointestinal transit times to those of control tortoises. Gastrointestinal transit times were determined by feeding 30 plastic markers to the tortoises, and recording the time until 85% of the markers were recovered from the stool of each animal. When compared to controls, none of the motility agents significantly affected the total gastrointestinal transit time.

Supplemental parenteral nutrition in the critically ill patient: a retrospective study

Objective: To determine the effect of supplemental parenteral nutrition (PN) on duration of ICU and hospital stay and mortality in critically ill patients. Design: Retrospective, matched cohort study. Setting: Tertiary care hospital intensive care unit. Subjects: Twenty-eight critically ill patients received both PN and enteral nutrition (EN) during their ICU stay. From 132 patients who received only EN, we selected 28 patients who were matched with patients who received EN and PN on APACHE II score (+4), age (+) 20 years, and then by ICU admission diagnosis. Intervention: None. Measurements and main results: From each patient's chart, we abstracted data on protein and energy requirements, amount and type of nutrition support received, use of motility agents and narcotics, length of ICU and hospital stay and mortality status. Patients in both groups were well matched with respect to age and APACHE II score. Patients who received both PN and EN received more energy and protein than patients who received EN...

Urokinase receptor-dependent and -independent p56/59(hck) activation state is a molecular switch between myelomonocytic cell motility and adherence.

Anchorage-independent myelomonocytic cells acquire adherence within minutes of differentiation stimuli, such as the proteolytically inactive N-terminal fragment of urokinase binding to its cognate glycosylphosphatidylinositol (GPI)-anchored receptor. Here, we report that urokinase-treated differentiating U937 monocyte-like cells exhibit a rapid and transient inhibition of p56/59(hck) and p55(fgr) whereas no changes in the activity of other Src family kinases, such as p53/56(lyn) and p59(fyn) were observed. U937 transfectants expressing a kinase-defective (Lys267 to Met) p56/59(hck) variant exhibit enhanced adhesiveness and a marked F-actin redistribution in thin protruding structures. Conversely, urokinase as well as expression of wild-type or constitutively active (Tyr499 to Phe) p56/59(hck) stimulates the directional migration of uninduced U937 cells. Accordingly, expression of constitutively active or kinase inactive p56/59(hck) selectively prevents urokinase receptor-dependent induction of either adhesion or motility, indicating that a specific activation state of p56/59(hck) is required for each cell response. In conclusion, modulation of the intracellular p56/59(hck) tyrosine kinase activity switches cell motility towards adherence, providing a mutually exclusive mechanism to regulate these properties during monocyte/macrophage differentiation in vivo.

The efficacy of extended-interval dosing of omeprazole in keeping gastroesophageal reflux disease patients symptom free.

The potential economic advantage of alternate-day therapy for GERD maintenance must be weighed against the potential cost of failure before it can be widely instituted. The studies presented have helped develop a clinical picture of the patients who may benefit from alternate-day therapy without risk of complications or potential increases in management costs. Bank et al., reporting on a group of patients, found that patients with Grade II-IV disease had a 61% success rate at two to eight years. Bank defined success as both maintenance of endoscopic healing and symptom control. Ladas et al. found a 66.7% success rate defined as clinical and endoscopic remission in Grades II-III disease. Kurucar et al. monitored symptom control and esophageal complications in his patients and found the regimen to have a 26% success rate in Grades III-IV disease. Lind et al. found that 83% of patients could remain symptom free with on-demand therapy if they were endoscopy-negative at baseline. The results of the Mantides et al. study are important because they imply that alternate-day omeprazole therapy may be more effective than alternatives for step-down treatment, such as ranitidine or cisapride. Furthermore, patients can be educated to increase their frequency of use if symptoms should arise. Not only does this give the patient a sense of self-empowerment over his or her disease state, but it avoids the cost of switching to a PPI due to failure with an H2RA or a motility agent. Alternate-day use of omeprazole should be attempted only during the maintenance phase of GERD therapy. Patients requiring >20 mg/d to achieve healing appeared to be poor candidates for alternate-day omeprazole maintenance therapy. Based on available studies, it would seem that patients with Grades 0-II GERD would benefit most from alternate-day therapy. A role for alternate-day therapy in Grades III-IV is apparent from the results presented but requires greater caution in view of the differing success rates (26-61%) in various studies. With Grades II-III esophagitis, a mean 24-hour gastric pH >6 and a gastric pH <4 less than 10% of the time during the initial healing phase with omeprazole 20 mg/d appeared to be associated with success on alternate-day therapy. Evidence that all marketed PPIs have similar success is not available and should not be extrapolated from the data presented. Evidence that downward dosage adjustments of PPIs versus extending dosage intervals are effective in the maintenance of GERD should be recognized. Lansoprazole has been approved for treating erosive esophagitis at 30 mg/d, with the maintenance dose established at 15 mg/d. Studies showing that lansoprazole 15 mg/d is more effective than alternate-day therapy with lansoprazole 30 mg exist, although similar studies with omeprazole have not been performed. The abstracts describing the use of alternate-day omeprazole accounted for all enrollees and included endoscopic grading or pH monitoring to document disease severity at baseline. Most also included these same objective measures as end points in combination with symptom control. This strengthens the data since the positive predictive value of typical symptoms is variable. However, there are also several significant limitations. Abstracts provide only limited information on methods. All studies other than Lind et al. lacked randomization. This study was also the only one that blinded patients to their treatment. Sample sizes for the majority of the trials were quite small. Statistical analyses were not performed on any of the trial results with the exception of the trial by Lind et al. In light of the lack of evidence of statistical significance as well as study design flaws, conclusions should be drawn cautiously. Larger well-designed trials looking at both the efficacy and cost-effectiveness of alternate day omeprazole are required before a definitive recommendation can be made.

The Effect of an Rx-to-OTC Switch on Medication Prescribing Patterns and Utilization of Physician Services

Prescription medications are being switched to over-the-counter (OTC) status with increasing frequency. Information is limited regarding the impact of OTC availability on the use of prescription forms of those products and on the utilization of health care services. To determine the impact of OTC availability of H2-receptor antagonists on medication prescribing patterns and utilization of physician services among a population of chronic users of those agents. A retrospective study was conducted to evaluate changes in the number of prescriptions filled for H2-receptor antagonists and other gastrointestinal agents (proton pump inhibitors, gastric motility agents, and sucralfate), and ambulatory medical encounters with physicians during a one-year period before (July 1, 1994-June 30, 1995) and after OTC availability of H2-receptor antagonists (July 1, 1995-June 30, 1996). Changes in the prescription drug costs for gastrointestinal agents were also estimated. Members of the Fallon Community Health Plan, a mixed-model HMO located in Central and Eastern Massachusetts (July 1, 1994-June 30, 1996) who were dispensed at least one H2-receptor antagonist during each quarter for the period between July 1, 1994 through June 30, 1995. Mean absolute differences in the frequencies of drug dispensings and ambulatory encounters and prescription drug costs during the pre-OTC (July 1, 1994-June 30, 1995) and post-OTC switch (July 1, 1995-June 30, 1996) periods were calculated. For the one-year period after OTC availability H2-receptor antagonists, we estimated that the mean absolute number of prescriptions dispensed for H2-receptor antagonists was reduced by 1.5 prescriptions (P < 0.001) and the mean number of prescriptions dispensed for all gastrointestinal agents was reduced by 1.3 prescriptions (P < 0.001) among chronic users of these agents. The number of dispensings of gastrointestinal agents was similarly reduced in the population of chronic users with a diagnosis of gastroesophageal reflux disease (GERD). OTC availability was not associated with an increase in physician visits, overall or for GERD-related conditions. The findings of this study suggest that the prescription-to-OTC switch of H2-receptor antagonists reduced the number of prescriptions for those agents dispensed among a population of chronic users of those drugs in a managed care setting without increasing physician visits.

How Well Do Critically Ill Patients Tolerate Early, Intragastric Enteral Feeding? Results of a Prospective, Multicenter Trial

Objective: To evaluate whether critically ill patients tolerate early, intragastric enteral feedings. Design: Multicenter, prospective cohort study. Setting: Eight mixed intensive care units at tertiary care hospitals. Patients: We recruited mechanically ventilated critically ill patients expected to remain ventilated &gt;48 hours. We enrolled 120 patients; the feeding protocol was used in 95. Forty percent were women, the mean age was 55.1 ± 18.9 years, and the mean APACHE II score was 21.6 ± 70.6. Interventions: We used a standardized feeding protocol that initiated enteral nutrition (EN) within 48 hours of admission at 25 mL/h and checked gastric residuals every 4 hours. At every 4‐hour interval, the feeding rate was increased by 25 mL/h to the target rate, if the residual volume was &lt;200 mL. If the residual volume was &gt;200 mL, the feedings were discontinued temporarily. All patients were fed in the stomach. Motility agents were allowed if the patient had high gastric residuals. Main outcomes: Time elapsed from admission to the intensive care unit (ICU) to initiation of EN, tolerance (amount of EN received over the amount needed to receive to meet energy requirements), gastrointestinal dysfunction (eg, high gastric residuals), and ICU‐acquired pneumonia. Results: Patients were started on EN 35.2 ± 15.6 hours after admission. Fifty‐nine of 95 (62%) received &gt;90% of their energy requirements for &gt;2 consecutive days. Over the entire study period the average tolerance was 65.9%. Reasons why EN was interrupted or delayed included high gastric residuals, procedures, feeding tube problem, and diarrhea. The incidence of pneumonia in this cohort was 10 of 95 or 10.5%. Conclusions: Early intragastric EN is safe and feasible and is tolerated in a majority of critically ill patients. High gastric residuals represents a major obstacle to success.

Effects of cinitapride on gastric ulceration and secretion in rats.

The aim of the present study was to examine the effects of cinitapride, a novel prokinetic benzamide-stimulating gastrointestinal motility agent, on gastric secretion and ulceration in rats and elucidate some possible vascular and anti-oxidant mechanisms of such protection. Male Wistar rats. Cinitapride (CNT, Lab. Almirall, S.A.) (0.25, 0.5, and 1 mg/kg) and 5-hydroxytryptamine (5-HT, Sigma Chemical Co., St. Louis, MO, USA) (10 mg/kg), administered intraperitoneally (i.p.). Gastric ulceration was induced by instillation of 1 mL/100 g animal of 50% (v/v) ethanol in distilled water and by pylorus-ligated rat model. Gastric microvascular changes, and the activity of myeloperoxidase (as a marker of neutrophil infiltration) and glutathione peroxidase (an important enzyme in scavenging of lipid peroxides) were determined. The results were compared with those of 5-HT. The data were evaluated using Student's t-test for paired data and the non-parametric Mann-Whitney U-test. In 4 h pyloric-ligated animals, i.p. CNT did not significantly reduce the incidence of gastric mucosal damage, and no significant differences were found in the values of total volume and acidity. However, CNT caused a marked and dose-dependent reduction of haemorrhagic lesions induced by 50% v/v ethanol. These protective effects were specifically related to a reduction of neutrophil infiltration. CNT at the dose of 1 mg/kg raised the decreased glutathione peroxidase activity to the control level. In contrast, pretreatment with 5-HT worsened the ethanol-induced erosions, but did not significantly induce any gastric microvascular changes. However, the myeloperoxidase activity rose markedly and the glutathione peroxidase levels decreased significantly in the mucosa injured by 50% v/v ethanol. This study demonstrates a new gastroprotective feature of CNT that could be partly explained not only through reduction of neutrophil toxicity but also by an increased synthesis of free-radical scavenging enzymes such as glutathione peroxidase. Furthermore, it is likely that serotonergic-dependent mechanisms are also involved via 5-HT2-receptor blockade and 5-HT1 receptor activation.

Effects of cisapride on ulcer formation and gastric secretion in rats: Comparison with ranitidine and omeprazol

1. 1. The antiulcerogenic effects of cisapride, a potent benzamide-stimulating gastrointestinal motility agent, were studied on cold-restraint and pylorus-ligated gastric ulcers. Acidity, composition of gastric secretion, and quantitative and qualitative changes on mucus glycoprotein content were also determined. These effects were compared with those of ranitidine (50 mg/kg) and omeprazol (10 mg/kg). 2. 2. Oral cisapride (10–100 mg/kg) dose-relatedly and significantly ( P<0.01, P<0.05) decreased the severity of the lesions induced by cold-restraint stress. In stressed rats, cisapride increased the amount of mucus secretion and markedly enhanced the glycoprotein content. Morphometric evaluation of mucus secretion revealed a significant increase in both the PAS area (neutral glycoproteins) and Alcian blue area (sulfated glycoproteins). 3. 3. In 4 h pyloric-ligated animals, cisapride (10–100 mg/kg) showed a significant reduction in the number and severity of ulcers ( P<0.01) and histamine concentration ( P<0.01, P<0.001). In addition, at the highest doses (50–100 mg/kg), cisapride produced a significant decrease in acidity; however, it did not alter the gastric volume secretion or pepsin concentrations. 4. 4. These results suggest that cisapride shows antiulcerogenic effects which could possibly be explained through antisecretory and cytoprotective mechanisms involving an enhancement of cuality and production of gastric mucus.

Prescribing patterns for dyspepsia in primary care: a prospective study of selected general practitioners.

To define prescribing patterns for symptomatic dyspeptic patients in a cross-section of general practitioners in Leeds, United Kingdom. Nine general practitioners from a range of practices took part in a prospective observational study of prescribing patterns for dyspepsia. All consultations with symptomatic dyspeptic patients were recorded over a 4-month period. Symptoms were recorded as ulcer-like, reflux-like, or nonspecific, and details of recent therapy, previous investigations and any prescription issued were noted. 257 consecutive consultations were recorded (new patients 23%, consulted before but not investigated 33%, previously investigated 44%). 93% of consultations resulted in a prescription (antacids 24%, prokinetic/motility agent 8%, H2-receptor antagonist 36%, proton pump inhibitor 24%, Helicobacter pylori eradication therapy 8%). 42.5% of new patients received an acid-suppressing drug as first-line therapy, of which only 32% had tried over-the-counter remedies. Symptom-type (ulcer-like, reflux-like or nonspecific) significantly influenced choice of empiric therapy (P < 0.001), though prescribing was still variable. Although around 60% of patients with previously negative investigations or only minor disease received acid-suppressing drugs, such patients were six times more likely to receive 'less potent' treatments (no prescription, antacid or motility agent) than those with known acid-peptic disease (odds ratio 6.23, P < 0.01). Only 30% of patients with previously documented peptic ulcer received H. pylori eradication therapy, yet patients with a wide range of other diagnoses received this form of treatment. Management guidelines may help to promote a more consistent and selective use of newer treatments, and promote more cost-effective patient care.

Motility agents for the placement of weighted and unweighted feeding tubes in critically ill patients

Motility agents for the placement of weighted and unweighted feeding tubes in critically ill patients

Pseudo-Obstruction in Children

Pseudo-obstruction of the gastrointestinal tract is a rare disorder of impaired gastrointestinal motility. The more common symptoms of pseudo-obstruction in the infant or child include dysphagia, nausea, vomiting, abdominal distention, abdominal pain, and constipation. The majority of children have symptoms within the first year of life. Chronic cases of pseudo-obstruction are associated with neuropathic or myopathic changes in other parts of the body. Bladder dysfunction and neurological problems have been reported. The diagnosis of pseudo-obstruction is based on history, physical examination, radiographic studies and motility studies. Advances in medical technology have facilitated the identification of abnormal motility patterns in children. Therapy for pseudo-obstruction is primarily supportive. The use of motility agents has been unsuccessful in treating pseudo-obstruction. Nutritional and antibiotic therapy are the mainstays of treatment. Nursing interventions, patient/family education and advances in home care technology have improved the quality of life for children with pseudo-obstruction. Small bowel transplantation offers hope for the future.

Effects of Metoclopramide on Detrusor Function

Metoclopramide (Reglan) has been widely used as a motility agent because of its contractile effects on gastrointestinal smooth muscle. This agent also may demonstrate significant effects in the urinary system; however, controlled studies of possible effects on bladder function have not been previously reported.Metoclopramide effects on the detrusor smooth muscle were studied using a canine model system. Metoclopramide was compared with bethanechol chloride and a control substance in a random double blind study.Preliminary data from this animal model suggests that metoclopramide significantly increased detrusor contractility as manifested by a decrease in bladder capacity, an increase in detrusor peak voiding pressure and a decrease in post-void residual volume. These effects were similar to those manifested by parenteral bethanechol chloride.