Background: Cisapride has been shown to have not only prokinetic effects, b
ut also salivary stimulating effects. Both of these mechanisms play an impo
rtant role in the acid clearance of the oesophagus.
Aim: To access the efficacy of cisapride in facilitating acid clearance in
patients with symptomatic gastrooesophageal reflux disease.
Methods: Fifteen older adults and 15 younger adults with symptomatic gastro
-oesophageal reflux disease completed the study. The acid clearance test wa
s accomplished by infusing 15 mL of 0.1 N HCl into the distal oesophagus, a
nd the number of swallows was determined to achieve an oesophageal pH of 4.
0. This was accomplished under baseline conditions and salivary stimulation
with a peppermint lozenge. After 1 week of treatment with cisapride (10 mg
, q.d.s.), the acid clearance test was repeated.
Results: The lozenge produced a significant decrease in the number of swall
ows compared to baseline in both groups (P < 0.01). There was a significant
decrease in the number of swallows after the treatment with cisapride comp
ared to baseline in both groups (P < 0.01). No significant difference was f
ound in the number of swallows when comparing cisapride with lozenge.
Conclusions: Cholinergic stimulation of salivation is an effective means of
facilitating oesophageal acid clearance. Drugs, such as 5 hydroxytriptamin
e (5-HT)(4)-receptor agonists, should be considered as potentially importan
t compounds in the treatment of gastrooesophageal reflux disease.