Ramirez B, Richter J E
Division of Gastroenterology, University of Alabama, Birmingham 35294.
Aliment Pharmacol Ther. 1993 Feb;7(1):5-20. doi: 10.1111/j.1365-2036.1993.tb00064.x.
Prokinetic agents are drugs that increase contractile force and accelerate intraluminal transit. They are often used in treating disorders of gastrointestinal motility including gastro-oesophageal reflux disease (GERD). The most widely studied agents include bethanechol, metoclopramide, domperidone and cisapride. These drugs act either by enhancing the effect of acetylcholine or by blocking the effect of an inhibitory neurotransmitter such as dopamine. With the exception of cisapride, the clinical efficacy of the various prokinetic agents in treating GERD has not been confirmed consistently. These agents have variable effects on oesophageal and gastric motor function and are fraught with side-effects. They are effective in relieving mild reflux symptoms but do not predictably heal oesophagitis. On the other hand, cisapride is thus far the most effective prokinetic agent studied for the treatment of GERD. It relieves reflux symptoms and promotes healing of grade I-II oesophagitis, with few side-effects or tachyphylaxis. Its most important role may be in the maintenance treatment of GERD either as a single agent or in combination therapy with an H2-antagonist after oesophagitis healing.
促动力药是一类能增强收缩力并加速管腔内转运的药物。它们常用于治疗包括胃食管反流病（GERD）在内的胃肠动力障碍。研究最广泛的药物包括氨甲酰甲胆碱、甲氧氯普胺、多潘立酮和西沙必利。这些药物要么通过增强乙酰胆碱的作用，要么通过阻断多巴胺等抑制性神经递质的作用来发挥作用。除西沙必利外，各种促动力药治疗GERD的临床疗效尚未得到一致证实。这些药物对食管和胃运动功能有不同影响，且副作用较多。它们能有效缓解轻度反流症状，但不能可靠地治愈食管炎。另一方面，西沙必利是迄今为止研究用于治疗GERD最有效的促动力药。它能缓解反流症状并促进Ⅰ - Ⅱ级食管炎的愈合，副作用或快速耐受性较少。其最重要的作用可能在于GERD的维持治疗，可单独使用或在食管炎愈合后与H2拮抗剂联合治疗。
