Metoclopramide esophagitis

Metoclopramide increases lower esophageal sphincter tone, aids gastric emptying, and accelerates transit through the small bowel, possibly through the release of acetylcholine. 

Symptomatic gastroesophageal reflux 10 to 15 mg orally up to 4 times daily 30 minutes before each meal and at bedtime. If symptoms occur only intermittently or at specific times of the day, single doses up to 20 mg prior to the provoking situation may be preferred rather than continuous treatment. Occasionally, patients who are more sensitive to the therapeutic or adverse effects of metoclopramide (eg, elderly) will require only 5 mg/dose. Guide therapy directed at esophageal lesions by endoscopy. Therapy longer than 12 weeks has not been evaluated and cannot be recommended. 

Metoclopramide is available for clinical use in the USA domperidone is available in many other countries. These agents are sometimes used in the treatment of symptomatic GERD but are not effective in patients with erosive esophagitis. Because of the superior efficacy and safety of antisecretory agents in the treatment of heartburn, prokinetic agents are used mainly in combination with antisecretory agents in patients with regurgitation or refractory heartburn. 

Cisapride is structurally similar to metoclopramide, but has no dopamine receptor antagonist activity and hence no central antiemetic effect. However, because it stimulates the release of acetylcholine in the gastrointestinal tract it is effective in conditions such as reflux esophagitis and gastroparesis. During clinical trials, the most frequent unwanted effects were diarrhea (5-11%) and abdominal pain (16% with 20 mg bd). 

Bethanechol is a synthetic derivative of acetylcholine and is not degraded by cholinesterase. Bethanechol has been used in humans to increase lower esophageal sphincter (LES) tone and to enhance gastric emptying. The cholinergic side-effects (salivation, abdominal discomfort) of bethanechol have reduced its use in human medicine since the introduction of metoclopramide and cisapride. 

Metoclopramide, a dopamine antagonisf increases LES pressure in a dose-related manner, and accelerates gastric emptying in gastroesophageal reflux patients. Unhke cisapride, however, metoclopramide does not improve esophageal clearance. Metoclopramide... 

Metoclopramide is an antidopaminergic/GI stimulant that stimulates upper GI tract motility, resulting in accelerated gastric emptying and intestinal transit and increased resting tone of lower esophageal sphincter. It exerts antiemetic... 

Bloom, in 1995, gathered economic data in a single, blind, randomized controlled trial comparing omeprazole, 20 mg each day, to ranitidine, 150 mg each day, plus metoclopramide, 10 mg four times daily, in 184 patients with erosive esophagitis. Esophagitis was verified by endoscopy before entry into the trial. Healing was confirmed by endoscopy at the end of 4 weeks and, if necessary, at the end of 8 weeks of treatment. Patients kept a daily symptom diary and also recorded the numbers and types of medical services used outside those required by the protocol and direct nonmedical costs, such as meals... 

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