Abstract
Objectives
Tegaserod may enhance upper gut transit, but, its prokinetic effects on antral/small bowel motility and how this compares with erythromycin is unknown. We prospectively assessed and compared the effects of tegaserod and erythromycin on upper gut motility.
Methods
In an open label, non-crossover study, 22 patients (M/F=4/18; mean age=37 years) with symptoms of upper gut dysmotility underwent 24-hour ambulatory antroduodenojejunal manometry with a six-sensor solid state probe. The effects of 12 mg oral tegaserod were compared with 125 mg intravenous erythromycin by quantifying pressure wave activity and assessing motor patterns.
Results
Motor activity increased (p<0.05) in antrum, duodenum and jejunum with both drugs when compared to baseline period. The motor response with tegaserod was higher (p<0.05) in jejunum and occurred during the second or third hours, whereas with erythromycin, it was higher (p<0.05) in antrum and occurred within 30 minutes. After tegaserod, a ‘fed-response’ like pattern was seen whereas after erythromycin, large amplitude (>100 mmHg) antral contractions at 3 cycles per minute were seen. Following tegaserod and erythromycin, phase III MMCs occurred in 12 (55%) and 8 (36%) patients respectively (p>0.05).
Conclusions
Both drugs increase upper gut motility and induce MMC’s, but exert a differential response. Tegaserod produces a more sustained prokinetic effect in the duodenum/jejunum, whereas erythromycin predominantly increases antral motor activity.
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References
El-Serag HB, Talley NJ. Systemic review: the prevalence and clinical course of functional dyspepsia. Aliment Pharmacol Ther 2004;19:643–654.
Bonapace ES, Maurer AH, Davidoff S, Krevsky B, Fisher RS, Parkman HP. Whole gut transit scintigraphy in the clinical evaluation of patients with upper and lower gastrointestinal symptoms. Am J Gastroenterol 2000;95:2838–2847.
Lee KJ, Kindt S, Tack J. Pathophysiology of functional dyspepsia. Best Pract Res Clin Gastroenterol 2004;18:707–716.
Tack J, Bisschops R, DeMarchi B. Causes and treatment of functional dyspepsia. Curr Gastroenterol Rep 2001;3:503–508.
Gershon MD. Review article: serotonin receptors and transporters — roles in normal and abnormal gastrointestinal motility. Aliment Pharmacol Ther 2004;20(Suppl 7):3–14.
Gershon MD. 5-HT (serotonin) physiology and related drugs. Curr Opin Gastroenterol 2000;16:113–120.
Gershon MD. Nerves, reflexes, and the enteric nervous system: pathogenesis of the irritable bowel syndrome. J Clin Gastroenterol 2005;39:S184–S193.
Gorard DA, Libby GW, Farthing MJ. 5-hydroxytryptamine and human small intestinal motility: effect of inhibiting 5-hydroxytryptamine reuptake. Gut 1994;35:496–500.
Hendrix TR, Atkinson M, Clifton JA, Ingelfinger FJ. The effect of 5-hydroxytryptamine on intestinal motor function in man. Am J Med 1957;23:886–893.
Jin JG, Foxx-Orenstein AE, Grider JR. Propulsion in guinea pig colon induced by 5-hydroxytryptamine (HT) via 5-HT4 and 5-HT3 receptors. J Pharmacol Exp Ther 1999;288:93–97.
Grider JR, Foxx-Orenstein AE, Jin JG. 5-Hydroxytryptamine-4 receptor agonists initiate the peristaltic reflex in human, rat, and guinea pig intestine. Gastroenterology 1998;115:370–380.
Prather CM, Camilleri M, Zinsmeister AR, McKinzie S, Thomforde G. Tegaserod accelerates orocecal transit in patients with constipation-predominant irritable bowel syndrome. Gastroenterology 2000;118:463–468.
Degen L, Petrig C, Studer D, Schroller S, Beglinger C. Effect of tegaserod on gut transit in male and female subjects. Neurogastroenterol Motil 2005;17:821–826.
Kamm MA, Muller-Lissner S, Talley NJ, et al. Tegaserod for the treatment of chronic constipation: a randomized, double-blind, placebo-controlled multinational study. Am J Gastroenterol 2005;100:362–372.
Maganti K, Onyemere K, Jones MP. Oral erythromycin and symptomatic relief of gastroparesis: a systematic review. Am J Gastroenterol 2003;98:259–263.
Tack J, Janssens J, Vantrappen G, et al. Effect of erythromycin on gastric motility in controls and in diabetic gastroparesis. Gastroenterology 1992;103:72–79.
Annese V, Janssens J, Vantrappen G, et al. Erythromycin accelerates gastric emptying by inducing antral contractions and improved gastroduodenal coordination. Gastroenterology 1992;102:823–828.
Annese V, Lombardi G, Frusciante V, Germani U, Andriulli A, Bassotti G. Cisapride and erythromycin prokinetic effects in gastroparesis due to type 1 (insulindependent) diabetes mellitus. Aliment Pharmacol Ther 1997;11:599–603.
Janssens J, Peeters TL, Vantrappen G, et al. Improvement of gastric emptying in diabetic gastroparesis by erythromycin. Preliminary studies. N Engl J Med 1990;322:1028–1031.
Lightfoot AJ, Eno M, Kreder KJ, O’Donnell MA, Rao SS, Williams RD. Treatment of postoperative ileus after bowel surgery with low-dose intravenous erythromycin. Urology 2007;69:611–615.
Szurszewski JH. A migrating electric complex of canine small intestine. Am J Physiol 1969;217:1757–1763.
Galligan JJ, Vanner S. Basic and clinical pharmacology of new motility promoting agents. Neurogastroenterol Motil 2005;17:643–653.
Talley NJ, Verlinden M, Geenen DJ, et al. Effects of a motilin receptor agonist (ABT-229) on upper gastrointestinal symptoms in type 1 diabetes mellitus: a randomised, double blind, place-bo controlled trial. Gut 2001;49:395–401.
Tack J, Vos R, Janssens J, Salter J, Jauffret S, Vandeplassche G. Influence of tegaserod on proximal gastric tone and on the perception of gastric distension. Aliment Pharmacol Ther 2003;18:1031–1037.
Thumshirn M, Fruehauf H, Stutz B, Tougas G, Salter J, Fried M. Clinical trial: effects of tegaserod on gastric motor and sensory function in patients with functio-nal dyspepsia. Aliment Pharmacol Ther 2007;26:1399–1407.
Tack J. A phase II placebo controlled randomized trial with tegaserod (T) in functional dyspepsia (FD) patients with normal gastric emptying (NGE). Gastroenterology 2002;122:154.
Zeng J, Zuo XL, Li YQ, Wei W, Lv GP. Tegaserod for dyspepsia and reflux symptoms in patients with chronic constipation: an exploratory open-label study. Eur J Clin Pharmacol 2007;63:529–536.
Chow MS, Ronfeld RA. Pharmacokinetic data and drug monitoring: I. antibiotics and antiarrhythmics. J Clin Pharmacol 1975;15:405–418.
Appel-Dingemanse S, Lemarechal MO, Kumle A, Hubert M, Legangneux E. Integrated modelling of the clinical pharmacokinetics of SDZ HTF 919, a novel selec-tive 5-HT4 receptor agonist, following oral and intravenous administration. Br J Clin Pharmacol 1999;47:483–491.
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Portions of this work were presented at Digestive Disease Week 2006 and published as abstracts; Gastroenterology, 2006, 130:4,S2:W1851; Gastroenterology, 2006, 130:4,S2:M2208.
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Nasr, I., Rao, S.S.C., Attaluri, A. et al. Effects of tegaserod and erythromycin in upper gut dysmotility: a comparative study. Indian J Gastroenterol 28, 136–142 (2009). https://doi.org/10.1007/s12664-009-0048-6
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DOI: https://doi.org/10.1007/s12664-009-0048-6