GASTRIC MOTILITY

Influence of erythromycin on gastric emptying and meal related symptoms in functional dyspepsia with delayed gastric emptying

J Arts, P Caenepeel, K Verbeke, J Tack

Department of Gastroenterology, University Hospitals Leuven, Belgium

Correspondence to:
Correspondence to:
Dr J Tack
Department of Gastroenterology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium; Jan.Tack{at}med.kuleuven.ac.be

Background and aims: Although delayed gastric emptying is considered a major pathophysiological mechanism in functional dyspepsia, the efficacy of prokinetic drugs has not been established. Recent studies using macrolide prokinetics were negative but receptor desensitisation may have played a role. The aim of the present study was to evaluate the influence on meal induced symptoms of acutely administered erythromycin in patients with gastroparesis.

Methods: In 20 patients with functional dyspepsia, gastric emptying was studied twice using the ¹⁴C octanoic acid and ¹³C glycin breath test to establish the reproducibility of the test. Breath samples were taken before the meal and at 15 minute intervals for a period of 240 minutes postprandially. At each breath sampling, the patient was asked to grade the intensity (0–3) of six dyspeptic symptoms. Twenty four patients (three men, mean age 43.5 (3) years) with dyspeptic symptoms and delayed gastric emptying were studied twice after pretreatment with saline or erythromycin intravenously.

Results: Meal related symptom severity scores were reproducible. Treatment with erythromycin significantly enhanced solid and liquid gastric emptying (t_1/2 146 (27) v 72 (7) minutes, respectively (p<0.01), and 87 (6) v 63 (5) minutes (p<0.001)). Only the severity of bloating was significantly improved by erythromycin (23 (3.9) v 14.5 (2.7); p<0.01); all other symptoms and the cumulative meal related symptom score were not altered by erythromycin.

Conclusions: In a setting where desensitisation played no role, erythromycin enhanced gastric emptying was not associated with a beneficial effect on meal related symptom severity.

Keywords: erythromycin; gastric emptying; functional dyspepsia; gastroparesis

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Bisschops, R, Karamanolis, G, Arts, J, Caenepeel, P, Verbeke, K, Janssens, J, Tack, J (2008). Relationship between symptoms and ingestion of a meal in functional dyspepsia. Gut 57: 1495-1503 [Abstract] [Full Text]  
• McOmber, M. A., Shulman, R. J. (2008). Pediatric Functional Gastrointestinal Disorders. Nutr Clin Pract 23: 268-274 [Abstract] [Full Text]  
• Abell, T. L., Camilleri, M., Donohoe, K., Hasler, W. L., Lin, H. C., Maurer, A. H., McCallum, R. W., Nowak, T., Nusynowitz, M. L., Parkman, H. P., Shreve, P., Szarka, L. A., Snape, W. J. Jr., Ziessman, H. A. (2008). Consensus Recommendations for Gastric Emptying Scintigraphy: A Joint Report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. J. Nucl. Med. Technol. 36: 44-54 [Abstract] [Full Text]  
• Stovold, R., Forrest, I. A., Corris, P. A., Murphy, D. M., Smith, J. A., Decalmer, S., Johnson, G. E., Dark, J. H., Pearson, J. P., Ward, C. (2007). Pepsin, a Biomarker of Gastric Aspiration in Lung Allografts: A Putative Association with Rejection. Am. J. Respir. Crit. Care Med. 175: 1298-1303 [Abstract] [Full Text]  
• Hawkyard, C. V., Koerner, R. J. (2007). The use of erythromycin as a gastrointestinal prokinetic agent in adult critical care: benefits versus risks. J Antimicrob Chemother 59: 347-358 [Abstract] [Full Text]  
• Karamanolis, G, Caenepeel, P, Arts, J, Tack, J (2007). Determinants of symptom pattern in idiopathic severely delayed gastric emptying: gastric emptying rate or proximal stomach dysfunction?. Gut 56: 29-36 [Abstract] [Full Text]  
• Kolnik, L., Ferrone, M. (2006). Erythromycin Dose of 70 mg Accelerates Gastric Emptying as Effectively as 200 mg in the Critically Ill. Nutr Clin Pract 21: 534-535 [Abstract] [Full Text]