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Different effects of an oral anticholinergic drug on gastroesophageal reflux in upright and supine position in normal, ambulant subjects: a pilot study.
Am J Gastroenterol. 1999 Apr; 94(4):925-30.AJ

Abstract

OBJECTIVE

There is controversy in the literature on the effects of anticholinergic drugs on gastroesophageal reflux. Our aim was to study more extensively the effects of an oral anticholinergic drug on esophageal motility and gastroesophageal reflux in normal ambulant subjects under different circumstances: upright, supine, fed, and fasted state.

METHODS

Fifteen healthy subjects (seven men, eight women), mean age 34 yr (range, 22-61 yr) underwent randomized placebo-controlled 16-h evening and overnight ambulatory esophageal motility/pH study. After a 3-day loading dose of either oral dicyclomine (Dic) 20 mg four times daily or placebo (Pla), an ambulatory esophageal motility/pH study was performed while taking medication or placebo. Each study was analyzed for meal, first and second h postprandial, upright and supine periods, and first 2 h supine after bedtime snack.

RESULTS

The mean number of reflux episodes decreased with dicyclomine during the first h postprandial (Dic, 1.9 vs Pla, 2.5; p < 0.05). During the first 2 h supine, mean number of reflux episodes increased with dicyclomine (Dic, 1.4 vs Pla, 0.8; p < 0.09), as did mean percent time pH < 4 (Dic, 2.6 vs Pla, 0.5; p < 0.04), with an increase in clearance time (Dic, 0.9 vs Pla, 0.3; p < 0.05; in min). Mean peristaltic amplitude decreased with dicyclomine during the 2nd h postprandial (Dic, 48.8 vs Pla, 56.3; p < 0.04).

CONCLUSIONS

Oral dicyclomine caused a decrease in early postprandial upright reflux episodes, but also significantly increased the percent time pH < 4 during the first two h supine. Therefore, its effects are dependent on body position and fasted or fed state. Our results justify additional studies with oral anticholinergic agents in patients with gastroesophageal reflux disease.

Authors+Show Affiliations

Department of Medicine, Allegheny University Hospitals, Graduate Hospital, Philadelphia, Pennsylvania, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10201458

Citation

Koerselman, J, et al. "Different Effects of an Oral Anticholinergic Drug On Gastroesophageal Reflux in Upright and Supine Position in Normal, Ambulant Subjects: a Pilot Study." The American Journal of Gastroenterology, vol. 94, no. 4, 1999, pp. 925-30.
Koerselman J, Pursnani KG, Peghini P, et al. Different effects of an oral anticholinergic drug on gastroesophageal reflux in upright and supine position in normal, ambulant subjects: a pilot study. Am J Gastroenterol. 1999;94(4):925-30.
Koerselman, J., Pursnani, K. G., Peghini, P., Mohiuddin, M. A., Katzka, D., Akkermans, L. M., & Castell, D. O. (1999). Different effects of an oral anticholinergic drug on gastroesophageal reflux in upright and supine position in normal, ambulant subjects: a pilot study. The American Journal of Gastroenterology, 94(4), 925-30.
Koerselman J, et al. Different Effects of an Oral Anticholinergic Drug On Gastroesophageal Reflux in Upright and Supine Position in Normal, Ambulant Subjects: a Pilot Study. Am J Gastroenterol. 1999;94(4):925-30. PubMed PMID: 10201458.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Different effects of an oral anticholinergic drug on gastroesophageal reflux in upright and supine position in normal, ambulant subjects: a pilot study. AU - Koerselman,J, AU - Pursnani,K G, AU - Peghini,P, AU - Mohiuddin,M A, AU - Katzka,D, AU - Akkermans,L M, AU - Castell,D O, PY - 1999/4/14/pubmed PY - 1999/4/14/medline PY - 1999/4/14/entrez SP - 925 EP - 30 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 94 IS - 4 N2 - OBJECTIVE: There is controversy in the literature on the effects of anticholinergic drugs on gastroesophageal reflux. Our aim was to study more extensively the effects of an oral anticholinergic drug on esophageal motility and gastroesophageal reflux in normal ambulant subjects under different circumstances: upright, supine, fed, and fasted state. METHODS: Fifteen healthy subjects (seven men, eight women), mean age 34 yr (range, 22-61 yr) underwent randomized placebo-controlled 16-h evening and overnight ambulatory esophageal motility/pH study. After a 3-day loading dose of either oral dicyclomine (Dic) 20 mg four times daily or placebo (Pla), an ambulatory esophageal motility/pH study was performed while taking medication or placebo. Each study was analyzed for meal, first and second h postprandial, upright and supine periods, and first 2 h supine after bedtime snack. RESULTS: The mean number of reflux episodes decreased with dicyclomine during the first h postprandial (Dic, 1.9 vs Pla, 2.5; p < 0.05). During the first 2 h supine, mean number of reflux episodes increased with dicyclomine (Dic, 1.4 vs Pla, 0.8; p < 0.09), as did mean percent time pH < 4 (Dic, 2.6 vs Pla, 0.5; p < 0.04), with an increase in clearance time (Dic, 0.9 vs Pla, 0.3; p < 0.05; in min). Mean peristaltic amplitude decreased with dicyclomine during the 2nd h postprandial (Dic, 48.8 vs Pla, 56.3; p < 0.04). CONCLUSIONS: Oral dicyclomine caused a decrease in early postprandial upright reflux episodes, but also significantly increased the percent time pH < 4 during the first two h supine. Therefore, its effects are dependent on body position and fasted or fed state. Our results justify additional studies with oral anticholinergic agents in patients with gastroesophageal reflux disease. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/10201458/Different_effects_of_an_oral_anticholinergic_drug_on_gastroesophageal_reflux_in_upright_and_supine_position_in_normal_ambulant_subjects:_a_pilot_study_ L2 - https://Insights.ovid.com/pubmed?pmid=10201458 DB - PRIME DP - Unbound Medicine ER -