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Cisapride improves enteral tolerance in pediatric short-bowel syndrome with dysmotility.
J Pediatr Gastroenterol Nutr. 2011 May; 52(5):590-4.JP

Abstract

BACKGROUND AND OBJECTIVES

Gastrointestinal dysmotility is common in pediatric short-bowel syndrome, leading to prolonged parenteral nutrition dependence. There is limited literature regarding the safety and efficacy of cisapride for this indication. The aim of the study was to describe the safety and efficacy of cisapride for enteral intolerance in pediatric short-bowel syndrome.

METHODS

Open-labeled pilot study in a limited access program for cisapride. Indications were short-bowel syndrome with underlying dysmotility and difficulty advancing enteral feeds despite standard therapies and without evidence of anatomic obstruction. Patients received cisapride 0.1 to 0.2 mg/kg per dose for 3 to 4 doses per day. We collected electrocardiogram, nutrition, and anthropometric data prospectively at study visits.

RESULTS

Ten patients with mean (SD) age of 30.3 (30.5) months were enrolled in our multidisciplinary pediatric intestinal rehabilitation program. Median (interquartile range [IQR]) duration of follow-up was 8.7 (3.1-14.3) months. Median (IQR) residual bowel length was 102 (85-130) cm. Median (IQR) citrulline level was 14.5 (10.5-31.3) μmol/L. Diagnoses included isolated gastroschisis (n = 3), gastroschisis with intestinal atresia (n = 4), necrotizing enterocolitis (n = 2), and long-segment Hirschsprung disease (n = 1). Six subjects had at least 1 prior bowel-lengthening procedure. Median (IQR) change in percentage enteral energy intake was 19.9% (15.4%-29.8%) during follow-up (P = 0.01). Seven patients improved in enteral tolerance during treatment and 2 were weaned completely from parenteral nutrition. Complications during therapy were prolonged corrected QT interval (n = 2), gastrointestinal bleeding (n = 2), D-lactic acidosis (n = 1), and death due to presumed sepsis (n = 1). Longitudinal analysis (general estimating equation model) showed a strong positive association between cisapride duration and improved enteral tolerance. Mean percentage of enteral intake increased by 2.9% for every month of cisapride treatment (P < 0.0001).

CONCLUSIONS

Cisapride is a potentially useful therapy in patients with pediatric short-bowel syndrome with gastrointestinal dysmotility. We observed modest improvement in feeding tolerance where prior treatments failed; however, patients treated with cisapride require careful cardiac monitoring because corrected QT prolongation occurred in 20% of our cohort.

Authors+Show Affiliations

Center for Advanced Intestinal Rehabilitation, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, 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
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

21502831

Citation

Raphael, Bram P., et al. "Cisapride Improves Enteral Tolerance in Pediatric Short-bowel Syndrome With Dysmotility." Journal of Pediatric Gastroenterology and Nutrition, vol. 52, no. 5, 2011, pp. 590-4.
Raphael BP, Nurko S, Jiang H, et al. Cisapride improves enteral tolerance in pediatric short-bowel syndrome with dysmotility. J Pediatr Gastroenterol Nutr. 2011;52(5):590-4.
Raphael, B. P., Nurko, S., Jiang, H., Hart, K., Kamin, D. S., Jaksic, T., & Duggan, C. (2011). Cisapride improves enteral tolerance in pediatric short-bowel syndrome with dysmotility. Journal of Pediatric Gastroenterology and Nutrition, 52(5), 590-4. https://doi.org/10.1097/MPG.0b013e3181fe2d7a
Raphael BP, et al. Cisapride Improves Enteral Tolerance in Pediatric Short-bowel Syndrome With Dysmotility. J Pediatr Gastroenterol Nutr. 2011;52(5):590-4. PubMed PMID: 21502831.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cisapride improves enteral tolerance in pediatric short-bowel syndrome with dysmotility. AU - Raphael,Bram P, AU - Nurko,Samuel, AU - Jiang,Hongyu, AU - Hart,Kristen, AU - Kamin,Daniel S, AU - Jaksic,Tom, AU - Duggan,Christopher, PY - 2011/4/20/entrez PY - 2011/4/20/pubmed PY - 2011/12/13/medline SP - 590 EP - 4 JF - Journal of pediatric gastroenterology and nutrition JO - J Pediatr Gastroenterol Nutr VL - 52 IS - 5 N2 - BACKGROUND AND OBJECTIVES: Gastrointestinal dysmotility is common in pediatric short-bowel syndrome, leading to prolonged parenteral nutrition dependence. There is limited literature regarding the safety and efficacy of cisapride for this indication. The aim of the study was to describe the safety and efficacy of cisapride for enteral intolerance in pediatric short-bowel syndrome. METHODS: Open-labeled pilot study in a limited access program for cisapride. Indications were short-bowel syndrome with underlying dysmotility and difficulty advancing enteral feeds despite standard therapies and without evidence of anatomic obstruction. Patients received cisapride 0.1 to 0.2 mg/kg per dose for 3 to 4 doses per day. We collected electrocardiogram, nutrition, and anthropometric data prospectively at study visits. RESULTS: Ten patients with mean (SD) age of 30.3 (30.5) months were enrolled in our multidisciplinary pediatric intestinal rehabilitation program. Median (interquartile range [IQR]) duration of follow-up was 8.7 (3.1-14.3) months. Median (IQR) residual bowel length was 102 (85-130) cm. Median (IQR) citrulline level was 14.5 (10.5-31.3) μmol/L. Diagnoses included isolated gastroschisis (n = 3), gastroschisis with intestinal atresia (n = 4), necrotizing enterocolitis (n = 2), and long-segment Hirschsprung disease (n = 1). Six subjects had at least 1 prior bowel-lengthening procedure. Median (IQR) change in percentage enteral energy intake was 19.9% (15.4%-29.8%) during follow-up (P = 0.01). Seven patients improved in enteral tolerance during treatment and 2 were weaned completely from parenteral nutrition. Complications during therapy were prolonged corrected QT interval (n = 2), gastrointestinal bleeding (n = 2), D-lactic acidosis (n = 1), and death due to presumed sepsis (n = 1). Longitudinal analysis (general estimating equation model) showed a strong positive association between cisapride duration and improved enteral tolerance. Mean percentage of enteral intake increased by 2.9% for every month of cisapride treatment (P < 0.0001). CONCLUSIONS: Cisapride is a potentially useful therapy in patients with pediatric short-bowel syndrome with gastrointestinal dysmotility. We observed modest improvement in feeding tolerance where prior treatments failed; however, patients treated with cisapride require careful cardiac monitoring because corrected QT prolongation occurred in 20% of our cohort. SN - 1536-4801 UR - https://www.unboundmedicine.com/medline/citation/21502831/Cisapride_improves_enteral_tolerance_in_pediatric_short_bowel_syndrome_with_dysmotility_ L2 - https://doi.org/10.1097/MPG.0b013e3181fe2d7a DB - PRIME DP - Unbound Medicine ER -