Abstract
We studied the effect of erythromycin on gastric emptying in nine patients with gastroparesis following truncal vagotomy and antrectomy, and assessed their clinical response to chronic oral erythromycin. Gastric emptying was evaluated using a solid-phase radio-labeled meal. Patients were studied after erythromycin 200 mg intravenously (N=9) and after an oral suspension of erythromycin 200 mg (N=7) each given 15 min after ingestion of the meal. Three parameters of gastric emptying were analyzed: half-emptying time (T1/2), area under the curve, and percent gastric residual at 2 hr. Nine patients were subsequently placed on oral suspension erythromycin 150 mg three times a day before meals (range 125–250 mg three times a day) and symptoms of nausea, vomiting, postprandial fullness, and abdominal pain were assessed before and after erythromycin. Intravenous erythromycin markedly accelerated the gastric emptying (all three parameters studied) of solids (P<0.01) in seven of nine patients with postsurgical gastroparesis [baselineT1/2 154±15 min; after intravenous erythromycin,T1/2 56±17 min (mean ±sem)]. Oral erythromycin enhanced (P<0.05) the gastric emptying rate (T1/2, area under the curve) in five of seven patients (baselineT1/2 146±16 min; after oral erythromycin,T1/2 87±20 min). Of the nine patients who were placed on oral maintenance erythromycin, three showed clinical improvement after two weeks. In summary, erythromycin significantly enhances gastric emptying in many patients with vagotomy and antrectomy-induced gastroparesis; however, only a small subset of patients respond clinically to chronic oral erythromycin.
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Janssens J, Peeters TL, Vantrappen G, Tack J, Urbain JL, De Roo M, Muls E, Bouillon R: Improvement of gastric emptying in diabetic gastroparesis by erythromycin. N Engl J Med 322:1028–1031, 1990
Weber Jr FH, Richards RD, McCallum RW: Erythromycin: A motilin agonist and gastrointestinal prokinetic agents. Am J Gastroenterol 88:485–490, 1993
Tomomasa T, Kuroume H, Arai H, Wakabayashi K, Itoh Z: Erythromycin induces migrating motor complex in human gastrointestinal tract. Dig Dis Sci 3:157–161, 1986
Otterson MF, Sarna SK: Gastrointestinal motor effects of erythromycin. Am J Physiol 259:G355-G367, 1990
Sarna SK, Soergel KH, Koch TR, Stone JE, Wood DM, Ryan RP, Avendorfer RC, Covanaugh JH, Nellans NH, Lee MB: Gastrointestinal motor effects of erythromycin in humans. Gastroenterology 101:1488–1496, 1991
Kondo Y, Torii K, Omura S, Itoh Z: Erythromycin and its derivatives with motilin-like biological activities inhibit the specific binding of125I motilin to duodenal muscle. Biochem Biophys Res Commun 150(12):877–882, 1988
Peeters T, Matthijs G, Depoortere I, Cachet T, Hoogmartens J, Vantrappen G: Erythromycin is a motilin receptor agonist. Am J Physiol 257:G470-G474, 1989
Inatomi N, Satoh H, Maki Y, Hashimoto N, Itoh Z, Omura S: An erythromycin derivative, EM-523, induces motilin-like gastrointestinal motility in dogs. J Pharmacol Exp Ther 251(2):707–712, 1989
Carlson RG, Hocking MP, Courington KR, Sninsky CA, Vogel SB: Erythromycin enhances delayed gastric emptying in dogs after Roux-Y antrectomy. Am J Surg 161(1):31–35, 1990
Elashoff JD, Reedy TJ, Meyer JH: Analysis of gastric emptying data. Gastroenterology 83:1306–1312, 1982
Dugas MC, Schade RR, Lhotsky D, Van Thiel D: Comparison of methods for analyzing gastric isotopic emptying. Am J Physiol 243:G237-G242, 1982
Mozwecz H, Pavel D, Pitrak D, Orellana P, Schlesinger PK, Layden TJ: Erythromycin stearate as prokinetic agent in postvagotomy gastroparesis. Dig Dis Sci 35(7):902–905, 1990
Christian RB, Cooke AR: Erythromycin and gastroparesis. Kans Med 91:259–261, 1990
Ormsbee HS III, Mir SS: The role of the cholinergic nervous system in the gastrointestinal response to motilinin vivo.In Gastrointestinal Motility in Health and Disease, 6th International Symposium on Gastrointestinal Motility. University Park Press, New York, 1978, pp 113–122
Depoortere I, Peeters TL, Vantrappen G: Erythromycin modulates motilin receptor density in rabbit. Gastroenterology 96(5):A119, 1989
Mathias JR, Fernandez A, Sninsky CA, Clench MH, Davis RH: Nausea, vomiting and abdominal pain after Roux-en-Y anastomosis: Motility of the jejunal limb. Gastroenterology 88:101–107, 1985
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Dr. Belinda Ramirez is in private practice in San Antonio, Texas.
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Ramirez, B., Eaker, E.Y., Drane, W.E. et al. Erythromycin enhances gastric emptying in patients with gastroparesis after vagotomy and antrectomy. Digest Dis Sci 39, 2295–2300 (1994). https://doi.org/10.1007/BF02087641
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DOI: https://doi.org/10.1007/BF02087641