Pharmacologic control of gastro-esophageal reflux in infants with cisapride

Abstract

Autonomic receptors in the upper gastro-intestinal tract permit pharmacologic manipulation of esophageal and gastric function. A new non-anti-dopaminergic, non-cholinergic, prokinetic agent, cisapride, was evaluated to determine it's efficacy in controlling gastro-esophageal reflux (GER) in infancy. Forty infants, mean age 6.5 months, were studied and their response to therapy determined by continuous measurement of lower esophageal pH over a 36-hour period. Five parameters were assessed in the erect, supine, and prone positions, both before and during short-term cisapride therapy. The drug was effective in reducing GER in 86% of the infants studied. Those infants who had a poor overall response to therapy could be identified retrospectively by the lack of improvement in esophageal acid clearance and frequency of reflux episodes; anatomic abnormalities were present in the majority of this subgroup. Cisapride is considered to be effective in the short-term treatment of primary GER of infancy, and a more prolonged assessment is indicated.