Robinson M
University of Oklahoma College of Medicine, Oklahoma City, USA.
Am Fam Physician. 1995 Sep 1;52(3):957-62, 965-6.
Prokinetic drugs theoretically have the ability to correct the pathophysiologic abnormalities of gastrointestinal motility that lead to gastroesophageal reflux disease. However, the prokinetic agents bethanechol and metoclopramide have been associated with central nervous system and other side effects, as well as uncertain efficacy. In addition, erythromycin seems unsuitable for use as an oral prokinetic agent. A recently introduced prokinetic agent, cisapride, has a minimum incidence of side effects and is effective in the treatment of reflux symptoms, but trials in the United States have not confirmed the symptomatic improvement or healing of erosive esophagitis that has been demonstrated in studies abroad. An expanded role may unfold for cisapride and additional new prokinetic drugs as primary therapy for reflux in some patients, as adjunctive treatment with an antisecretory agent, or as maintenance treatment for a subset of patients with gastroesophageal reflux. Therapy tailored to individual pathophysiology is appropriate and may offer cost savings and improved clinical outcome.
促动力药物理论上有能力纠正导致胃食管反流病的胃肠动力病理生理异常。然而，促动力剂氨甲酰甲胆碱和甲氧氯普胺已与中枢神经系统及其他副作用相关联，且疗效不确定。此外，红霉素似乎不适合用作口服促动力剂。最近引入的促动力剂西沙必利副作用发生率最低，对反流症状有效，但美国的试验尚未证实国外研究中所显示的糜烂性食管炎症状改善或愈合情况。西沙必利和其他新的促动力药物可能会在某些患者中发挥更广泛的作用，作为反流的主要治疗方法、与抗分泌剂联合治疗或作为一部分胃食管反流患者的维持治疗。针对个体病理生理情况进行治疗是合适的，可能会节省费用并改善临床结果。
