» Gastroenterology
Dr Peter Gillett looks at the options for treating reflux
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Dr Peter Gillett – concerns about reflux. |
Speaking at the Peebles meeting, Dr Peter Gillett, consultant gastroenterologist from Edinburgh, explained that doctors would need to perform diagnostic tests that should be performed before prescribing the drug.
“There have been a number of problems from people taking the drug and suffering severe cardiac problems or kidney failure. Most cases in children have involved preterm infants.
Interaction
There are cases where there has been an interaction with certain antibiotics (like erythromycin), antihistamine or antifungal treatments for conditions such as thrush. These other drugs compete with cisapride for the special enzymes in the liver (called cytochrome P450) that break such drugs down.
“There are some clear alternatives such as Domperidone or Metoclopromide – both of which are prokinetics like Cisapride.”
Prokinetics help the muscle of the gut move fluids and food through the digestive tract and help increase the tone of the sphincter muscle at the lower end of the oesophagus (keeps this ‘valve’ tighter) thus preventing reflux of acid into the oesophagus which can cause inflammation and pain.
Warnings
Warnings about dangers from cardiac arrests were given about 14 years ago but many CdLS people still cite Cisapride as a regular medication.
“People just need to be aware of the problems and remember to tell the doctor that they are on this drug. However, they may be better looking for alternatives.”
Most patients who are on this medication are and always will be fine, but need to be aware that they should not have certain medications co-prescribed and should always make their Doctor (and the pharmacist) aware that they are on Cisapride and that they should check that it is OK to be on the proposed drug.
Concerns
Most patients who are still on this medication will have had it started before the warnings came out. Their Doctors will have considered the pros and cons of them still being on it. Should you have any questions or specific concerns, parents should discuss with the GP or specialist that prescribed it.
Dr Gillett talked the CdLS families at Peebles through the options for treatment for reflux including new surgical techniques. He also reiterated the warning that has been given to families in the past, that checking for reflux was vital.
“I believe it is even more common than the medical literature suggests,” he said. He showed slides demonstrating how reflux in its more severe forms can develop into Barrett’s Syndrome.
It is hoped that a more detailed feature on the effect of Barrett’s will appear in a future edition of Reaching Out.
Reaching Out newsletter
October 2002