Comparison of cisapride and metoclopramide as oesophageal prokinetics in healthy humans

Objective To compare the prokinetic potencies of equal intravenous doses (10 mg) of cisapride and metoclopramide on oesophageal motility in healthy humans. Design Nine male volunteers were enrolled according to a double-blind, placebo-controlled, crossover design. Methods In each experiment, oesophageal motility was continuously recorded for 60 min in the fasting state. Analysis of motor events was computer-assisted. It referred to lower oesophageal sphincter pressure and relaxation, amplitude, duration, area, contractility and progression velocity of oesophageal peristalsis (wet swallows). Results Metoclopramide hastened progression velocity of proximal oesophageal peristalsis by 30% (P < 0.01) compared with placebo. In the distal oesophagus, metoclopramide raised the contraction amplitude by 9%, prolonged duration of contraction by 11% and increased the area under the contraction by 19% (P < 0.05). Cisapride increased the amplitude by 12%, prolonged duration by 14% (P < 0.05) and raised the area by 27% (P < 0.01). Lower oesophageal sphincter pressure increased with metoclopramide (P < 0.05) and, more distinctly, with cisapride (P < 0.0005) compared with the basal state. Lower oesophageal sphincter pressure was not changed by metoclopramide but rose by 28% with cisapride (P < 0.01) compared with placebo. Conclusions Cisapride and metoclopramide stimulate amplitude, duration and the area of distal, but not proximal, oesophageal peristalis to a similar extent. Cisapride is superior to metoclopramide in raising lower oesophageal sphincter pressure. These data support the use of cisapride as an oesophageal prokinetic.