Chronic oral treatment with cisapride decreases high bile salt reflux rates.

The effect of cisapride, a new gastrokinetic drug, on gastric emptying and duodenogastric reflux of bile salts was tested in healthy volunteers in a placebo-controlled double-blind randomized cross-over trial. Twenty subjects were treated with either 10 mg of cisapride, tid orally or with matching placebo tablets for 1 wk. On test days, the subjects were studied using a marker technique with gastric intubation in the fasting state and after feeding a mixed liquid meal. Cisapride did not affect gastric secretion and gastric emptying. There was a tendency to lower reflux rates after cisapride treatment both fasting (0.63 +/- 0.14 versus 0.38 mumol/min +/- 0.05 SEM) and after feeding (2.60 +/- 0.61 versus 1.88 mumol/min +/- 0.33 SEM). This was due to a decrease of high placebo reflux rates: the reduction of reflux rate achieved by cisapride was significantly correlated to the height of the placebo reflux rate (p less than 0.001). A similar relationship was found for gastric bile salt concentration (p less than 0.001). It is concluded that cisapride reduces high bile salt reflux. Therapeutic trials with this drug in diseases where high bile reflux is believed to play a pathogenic role are of interest.