Skip to main content

Advertisement

SpringerLink
Log in

Does the Use of Nizatidine, as a Pro-kinetic Agent, Improve Gastric Emptying in Patients Post-oesophagectomy?

  • original article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Purpose

Delayed gastric emptying following oesophagectomy is common and can often lead to weight loss, malnutrition and a poor quality of life. Animal models have shown that nizatidine, a histamine H2-receptor antagonist, has pro-kinetic properties and can accelerate gastric emptying. Patients post-oesophagectomy require long-term acid suppression medication; if nizatidine can improve gastric emptying, it can be adopted for its dual pharmacological actions.

Methodology

Twenty consecutive patients were prospectively enrolled in this trial following oesophagectomy. All patients were more than 6 months post-surgery and had no evidence of recurrent cancer. A baseline nuclear medicine scan following a radiolabelled meal was conducted and then repeated after 1 week of nizatidine (150 mg bd) treatment. Quality of life and eating comfort data were collected.

Results

Oesophagectomy causes a significant delay in gastric emptying. Early satiety (80%) and reflux (65%) were the most common post-operative complaints. The percentage of food remaining in the stomach at 60 min post-meal was significantly more than normal values in both the pre- and post-nizatidine studies. There is no advantage in using nizatidine as a pro-kinetic agent.

Conclusions

Impaired gastric emptying post-surgery causes a change in eating habits. Patients in this study did not lose a significant amount of weight despite all indicating worse eating comfort. Patients required more regular meals or snacks throughout the day and avoid foods that are difficult to swallow. It is likely that gastric motility only plays a small role in the emptying process and gravity combined with appropriate drainage procedures (pyloroplasty/pyloromyotomy) at the time of surgery are more important.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Finley RJ, Lamy A, Clifton J, Evans KG, Fradet G, Nelems B. Gastrointestinal function following oesophagectomy for malignancy. Am J Surg 1995;169(5):471–475. doi:10.1016/S0002-9610(99)80197-4.

    Article  PubMed  CAS  Google Scholar 

  2. Collard JM, Otte JB, Reynaert M, Kestens PJ. Quality of life three years or more after esophagectomy for cancer. J Thorac Cardiovasc Surg 1992;104:391–394.

    PubMed  CAS  Google Scholar 

  3. Morton KA, Karawande SV, et al. Gastric emptying after gastric interposition for cancer of the esophagus or hypopharynx. Ann Thorac Surg 1991;51:759–763.

    Article  PubMed  CAS  Google Scholar 

  4. Bonavina L, Anselmino M, et al. Functional evaluation of the intrathoracic stomach as an esophageal substitute. Br J Surg 1992;79:529–532. doi:10.1002/bjs.1800790618.

    Article  PubMed  CAS  Google Scholar 

  5. Collard JM, Romagnoli R, Otte JB, Kestens PJ. The denervated stomach as an oesophageal substitute is a contractile organ. Ann Surg 1998;227:33–39. doi:10.1097/00000658-199801000-00005.

    Article  PubMed  CAS  Google Scholar 

  6. Nakabayashi T, Mochiki E, Garcia M, Haga N, Kato H, Suzuki T, Asao T, Kuwano H. Gastropyloric motor activity and the effects of erythromycin given orally after oesophagectomy. Am J Surg 2002;183(3):317–323. doi:10.1016/S0002-9610(02)00796-1.

    Article  PubMed  Google Scholar 

  7. Burt M, Scott A, Williard WC, Pommier R, Yeh S, Bains MS, Turnbull AD, Fortner JG, McCormack PM, Ginsburg RJ. Erythromycin stimulates gastric emptying after esophagectomy with gastric replacement: a randomised clinical trial. J Thorac Cardiovasc Surg 1992;104:391–394.

    Google Scholar 

  8. Hill DK, Walsh TN, Hamilton D, Freyne P, O’Hare N, Byrne PJ, Hennessy TPJ. Erythromycin improves emptying of the denervated stomach after oesophagectomy. Br J Surg 1993;80:879–881. (July). doi:10.1002/bjs.1800800726.

    Article  PubMed  CAS  Google Scholar 

  9. Collard JM, Romagnoli R, Otte JB, Kestens PJ. Erythromycin enhances early postoperative contractility of the denervated whole stomach as an esophageal substitute. Ann Surg 1999;229(3):337–343. doi:10.1097/00000658-199903000-00006.

    Article  PubMed  CAS  Google Scholar 

  10. Mernis D, Turan A, Karamanlioglu B, Guler T, Yurdakoc A, Pamukcu Z, Turan N. Effect of preoperative oral use of erythromycin and nizatidine on gastric pH and volume. Anaesth Intensive Care 2002;30(4):428–432.

    Google Scholar 

  11. Peeters T, Matthijs G, Depoortere I, Cachet T, Hoogmartens J, Vantrappen G. Erythromycin is a motilin receptor agonist. Am J Physiol 1989;257:470–474. (G).

    Google Scholar 

  12. Kaneko H, Mitsuma T, Uchida K, Nagi H, Harada M, Kotera H. Nizatidine accelerates gastric emptying of a solid meal in rats. Dig Dis Sci 1995;40(9):2043–2051.

    Article  PubMed  CAS  Google Scholar 

  13. Ueki S, Seiki M, Yoneta T, Aita H, et al. Gastroprokinetic activity of nizatidine, a new H2-receptor antagonist, and its possible mechanism of action in dogs and rats. J Pharmacol Exp Ther 1993;264(1):152–157.

    PubMed  CAS  Google Scholar 

  14. Zarling EJ. Prokinetic activity of nizatidine: Implications for the management of patients with gastroesophageal reflux disease. Clin Ther 1999;21(12):2038–2046. doi:10.1016/S0149-2918(00)87235-5.

    Article  PubMed  CAS  Google Scholar 

  15. Koskenpato J, Punkkinen JM, Kairemo K, Farkkila M. Nizatidine and gastric emptying in functional dyspepsia. Dig Dis Sci 2008;53(2):352–357. doi:10.1007/s10620-007-9898-x.

    Article  PubMed  CAS  Google Scholar 

  16. Parkman HP, Pagano AP, Ryan JP. Ranitadine and nizatidine stimulate antral smooth muscle contractility via excitatory cholinergic mechanisms. Dig Dis Sci 1998;43:497–505. doi:10.1023/A:1018846604627.

    Article  PubMed  CAS  Google Scholar 

  17. Holscher AH, Voit H, Buttermann G, Siewert JR. Function of the intrathoracic stomach as esophageal replacement. World J Surg 1988;12:835–844. doi:10.1007/BF01655491.

    Article  PubMed  CAS  Google Scholar 

  18. Bemelman WA, Taat CW, Slors JF, Van Lanschot JJ, Obertop H. Delayed postoperative emptying after oesophageal resection is dependent on the size of the gastric substitute. J Am Coll Surg 1995;180(4):461–464.

    PubMed  CAS  Google Scholar 

  19. Heitmiller RF. Impact of gastric tube diameter on upper mediastinal anatomy after transhiatal esophagectomy. Dis Esophagus 2000;13(4):288–292. doi:10.1046/j.1442-2050.2000.00134.x.

    Article  PubMed  CAS  Google Scholar 

  20. Collard JM, Tinton N, Malaise J, Romagnoli R, Otte JB, Kestens PJ. Esophageal replacement: gastric tube or whole stomach? Ann Thorac Surg. 1995;60(2):261–266. doi:10.1016/0003-4975(95)00411-D.

    Article  PubMed  CAS  Google Scholar 

  21. Tabira Y, Sakaguchi T, Kuhara H, Teshima K, Tanaka M, Kawasuji M. The width of the gastric tube has no impact on outcome after esophagectomy. Am J Surg 2004;187:417–421. doi:10.1016/j.amjsurg.2003.12.008.

    Article  PubMed  Google Scholar 

  22. Fok M, Cheng SW, Wong J. Pyloroplasty versus no drainage in gastric replacement of the oesophagus. Am J Surg 1991;162(5):447–452. doi:10.1016/0002-9610(91)90258-F.

    Article  PubMed  CAS  Google Scholar 

  23. Kim JH, Lee HS, Kim MS, Lee JM, Kim SK. Balloon dilatation of the pylorus for delayed gastric emptying after oesophagectomy. Eur J Cardio-Thorac Surg 2008;33:1105–1111. doi:10.1016/j.ejcts.2008.03.012.

    Article  Google Scholar 

  24. Kent MS, Pennathur A, Fabian A, et al. A pilot study of botulinum toxin injection for the treatment of delayed gastric emptying following oesophagectomy. Surg Endosc 2007;21:754–757. doi:10.1007/s00464-007-9225-9.

    Article  PubMed  CAS  Google Scholar 

  25. Headrick JR, Nichols FC, Miller DL, et al. High grade esophageal dysplasia: long term survival and quality of life after oesophagectomy. Ann Thorac Surg 2002;73:1697–1703. doi:10.1016/S0003-4975(02)03496-3.

    Article  PubMed  Google Scholar 

  26. Evers AS, Maze M. Anaesthetic pharmacology—physiologic principals and clinical practice. Philadelphia: Churchill Livingston, 2004, pp 763–776.

    Google Scholar 

  27. Harasawa S, Miwa T. The effect of nizatidine on gastric emptying and plasma gastrin concentration in patients with peptic ulcer. Jpn Pharmacol Ther 1993;21:321–328.

    Google Scholar 

  28. Cooke AR. Duodenal acidification: role of the first part of duodenum in gastric emptying and secretion in dogs. Gastroenterology 1974;67:85–92.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Cabrini Hospital, 183 Wattletree Rd, Malvern, Victoria, 3144, Australia

    Paul J. Simpson, Andrew Smith & Simon Woods

  2. Cabrini Hospital, Malvern, Victoria, Australia

    Corinne Ooi, Jennifer Chong & Andrew Baldey

  3. Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia

    Margaret Staples

  4. Department of Epidemiology and Preventive Medicine, 183 Wattletree Rd, Malvern, Victoria, 3144, Australia

    Margaret Staples

  5. 178 Tooronga Rd, Glen Iris, Victoria, 3146, Australia

    Paul J. Simpson

Authors
  1. Paul J. Simpson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Corinne Ooi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jennifer Chong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrew Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrew Baldey
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Margaret Staples
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Simon Woods
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul J. Simpson.

Additional information

All authors are in agreement as to the content of this manuscript.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Simpson, P.J., Ooi, C., Chong, J. et al. Does the Use of Nizatidine, as a Pro-kinetic Agent, Improve Gastric Emptying in Patients Post-oesophagectomy?. J Gastrointest Surg 13, 432–437 (2009). https://doi.org/10.1007/s11605-008-0736-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-008-0736-z

Keywords

Search

Navigation