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Top 10 Drugs Most Commonly Used for GI Motility Disorders

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Gastrointestinal Motility Disorders

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Abstract

Disorders of gastrointestinal motility are among the most common and difficult clinical problems faced by practicing gastroenterologists. The purpose of this chapter is to review currently available drugs for the treatment of these conditions. Structures involved include the esophagus, stomach, and intestine. Atypical chest pain can arise from diffuse esophageal spasm and is treated with calcium channel blockers, nitrates, and other antispasm drugs such as phosphodiesterase inhibitors. Gastroparesis is managed with prokinetics although the need for new therapies is clear. Irritable bowel syndrome affects up to 30% of the population with anticholinergics and multiple new drugs improving patient outcomes. A new indication for drug therapy is opiate-induced constipation. Fortunately, given the complexity of motility problems, this is a field of rapid advancement with multiple new drugs in the pipeline.

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References

  1. Almansa C, Heckman MG, DeVault KR, Bouras E, Achem SR. Esophageal spasm: demographic, clinical, radiographic, and manometric features in 108 patients. Dis Esophagus. 2012;25(3):214–21. doi:10.1111/j.1442-2050.2011.01258.x. Epub 2011 Sep 23

    Article  CAS  PubMed  Google Scholar 

  2. Rice TW, Goldblum JR, Yearsley MM, Shay SS, Reznik SI, Murthy SC, Mason DP, Blackstone EH. Myenteric plexus abnormalities associated with epiphrenic diverticula. Eur J Cardiothorac Surg. 2009;35(1):22–27.; discussion 27. doi:10.1016/j.ejcts.2008.09.025.

    Article  PubMed  Google Scholar 

  3. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, Pandolfino JE, International High Resolution Manometry Working Group. The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27(2):160–74. doi:10.1111/nmo.12477. Epub 2014 Dec 3

    Article  CAS  PubMed  Google Scholar 

  4. Pandolfino JE, Roman S, Carlson D, Luger D, Bidari K, Boris L, Kwiatek MA, Kahrilas PJ. Distal esophageal spasm in high-resolution esophageal pressure topography: defining clinical phenotypes. Gastroenterology. 2011;141(2):469–75. doi:10.1053/j.gastro.2011.04.058. Epub 2011 May 6

    Article  PubMed  PubMed Central  Google Scholar 

  5. Khatami SS, Khandwala F, Shay SS, Vaezi MF. Does diffuse esophageal spasm progress to achalasia? A prospective cohort study. Dig Dis Sci. 2005;50(9):1605–10.

    Article  PubMed  Google Scholar 

  6. Leonard RG, Talbert RL. Calcium-channel blocking agents. Clin Pharm. 1982;1(1):17–33.

    CAS  PubMed  Google Scholar 

  7. Blackwell JN, Holt S, Heading RC. Effect of nifedipine on oesophageal motility and gastric emptying. Digestion. 1981;21(1):50–6.

    Article  CAS  PubMed  Google Scholar 

  8. Davies HA, Lewis MJ, Rhodes J, Henderson AH. Trial of nifedipine for prevention of oesophageal spasm. Digestion. 1987;36(2):81–3.

    Article  CAS  PubMed  Google Scholar 

  9. Thomas E, Witt P, Willis M, Morse J. Nifedipine therapy for diffuse esophageal spasm. South Med J. 1986;79(7):847–9.

    Article  CAS  PubMed  Google Scholar 

  10. Drenth JP, Bos LP, Engels LG. Efficacy of diltiazem in the treatment of diffuse oesophageal spasm. Aliment Pharmacol Ther. 1990;4(4):411–6.

    Article  CAS  PubMed  Google Scholar 

  11. Murray JA, Ledlow A, Launspach J, Evans D, Loveday M, Conklin JL. The effects of recombinant human hemoglobin on esophageal motor functions in humans. Gastroenterology. 1995;109(4):1241–8.

    Article  CAS  PubMed  Google Scholar 

  12. Gelfond M, Rozen P, Keren S, Gilat T. Effect of nitrates on LOS pressure in achalasia: a potential therapeutic aid. Gut. 1981;22(4):312–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Swamy N. Esophageal spasm: clinical and manometric response to nitroglycerine and long acting nitrites. Gastroenterology. 1977;72(1):23–7.

    CAS  PubMed  Google Scholar 

  14. Orlando RC, Bozymski EM. Clinical and manometric effects of nitroglycerin in diffuse esophageal spasm. N Engl J Med. 1973;289(1):23–5.

    Article  CAS  PubMed  Google Scholar 

  15. Moreland RB, Goldstein I, Traish A. Sildenafil, a novel inhibitor of phosphodiesterase type 5 in human corpus cavernosum muscle cells. Life Sci. 1998;62:309–18.

    Article  Google Scholar 

  16. Bortolotti M, Mari C, Giovannini M, Pinna S, Miglioli M, Pandolfo N. Effects of sildenafil on esophageal motility of normal subjects. Dig Dis Sci. 2001;46(11):2301–6.

    Article  CAS  PubMed  Google Scholar 

  17. Rhee PL, Hyun JG, Lee JH, Kim YH, Son HJ, Kim JJ, Paik SW, Rhee JC, Choi KW. The effect of sildenafil on lower esophageal sphincter and body motility in normal male adults. Am J Gastroenterol. 2001;96(12):3251–7.

    Article  CAS  PubMed  Google Scholar 

  18. Eherer AJ, Schwetz I, Hammer HF, Petnehazy T, Scheidl SJ, Weber K, Krejs GJ. Effect of sildenafil on oesophageal motor function in healthy subjects and patients with oesophageal motor disorders. Gut. 2002;50(6):758–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Fox M, Sweis R, Wong T, Anggiansah A. Sildenafil relieves symptoms and normalizes motility in patients with oesophageal spasm: a report of two cases. Neurogastroenterol Motil. 2007;19(10):798–803.

    Article  CAS  PubMed  Google Scholar 

  20. Bashashati M, Andrews C, Ghosh S, Storr M. Botulinum toxin in the treatment of diffuse esophageal spasm. Dis Esophagus. 2010;23(7):554–60. doi:10.1111/j.1442-2050.2010.01065.x. Epub 2010 May 4

    Article  CAS  PubMed  Google Scholar 

  21. Vanuytsel T, Bisschops R, Farré R, Pauwels A, Holvoet L, Arts J, Caenepeel P, De Wulf D, Mimidis K, Rommel N, Tack J. Botulinum toxin reduces dysphagia in patients with nonachalasia primary esophageal motility disorders. Clin Gastroenterol Hepatol. 2013;11(9):1115–1121.e2. doi:10.1016/j.cgh.2013.03.021. Epub 2013 Apr 13

    Article  CAS  PubMed  Google Scholar 

  22. Marjoux S, Pioche M, Benet T, Lanne JS, Roman S, Ponchon T, Mion F. Fatal mediastinitis following botulinum toxin injection for esophageal spasm. Endoscopy. 2013;45(Suppl 2. UCTN):E405–6. doi:10.1055/s-0033-1344908.

    PubMed  Google Scholar 

  23. Khashab MA, Messallam AA, Onimaru M, Teitelbaum EN, Ujiki MB, Gitelis ME, Modayil RJ, Hungness ES, Stavropoulos SN, El Zein MH, Shiwaku H, Kunda R, Repici A, Minami H, Chiu PW, Ponsky J, Kumbhari V, Saxena P, Maydeo AP, Inoue H. International multicenter experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video). Gastrointest Endosc. 2015;81(5):1170–7. doi:10.1016/j.gie.2014.10.011. Epub 2015 Jan 26

    Article  PubMed  Google Scholar 

  24. Camilleri M, Parkman HP, Shafi MA, Abell TL, Gerson L, American College of Gastroenterology. Clinical guideline: management of gastroparesis. Am J Gastroenterol. 2013;108(1):18–37.; quiz 38. doi:10.1038/ajg.2012.373.

    Article  CAS  PubMed  Google Scholar 

  25. Olausson EA, Störsrud S, Grundin H, Isaksson M, Attvall S, Simrén M. A small particle size diet reduces upper gastrointestinal symptoms in patients with diabetic gastroparesis: a randomized controlled trial. Am J Gastroenterol. 2014;109(3):375–85. doi:10.1038/ajg.2013.453. Epub 2014 Jan 14

    Article  CAS  PubMed  Google Scholar 

  26. Perkel MS, Moore C, Hersh T, Davidson ED. Metoclopramide therapy in patients with delayed gastric emptying: a randomized, double-blind study. Dig Dis Sci. 1979;24(9):662–6.

    Article  CAS  PubMed  Google Scholar 

  27. Perkel MS, Hersh T, Moore C, Davidson ED. Metoclopramide therapy in fifty-five patients with delayed gastric emptying. Am J Gastroenterol. 1980;74(3):231–6.

    CAS  PubMed  Google Scholar 

  28. Snape WJ Jr, Battle WM, Schwartz SS, Braunstein SN, Goldstein HA, Alavi A. Metoclopramide to treat gastroparesis due to diabetes mellitus: a double-blind, controlled trial. Ann Intern Med. 1982;96(4):444–6.

    Article  PubMed  Google Scholar 

  29. Bateman DN, Rawlins MD, Simpson JM. Extrapyramidal reactions with metoclopramide. Br Med J (Clin Res Ed). 1985;291(6500):930–2.

    Article  CAS  Google Scholar 

  30. Ganzini L, Casey DE, Hoffman WF, McCall AL. The prevalence of metoclopramide-induced tardive dyskinesia and acute extrapyramidal movement disorders. Arch Intern Med. 1993;153(12):1469–75.

    Article  CAS  PubMed  Google Scholar 

  31. Patterson D, Abell T, Rothstein R, Koch K, Barnett J. A double-blind multicenter comparison of domperidone and metoclopramide in the treatment of diabetic patients with symptoms of gastroparesis. Am J Gastroenterol. 1999;94(5):1230–4.

    CAS  PubMed  Google Scholar 

  32. Johannes CB, Varas-lorenzo C, Mcquay LJ, et al. Risk of serious ventricular arrhythmia and sudden cardiac death in a cohort of users of domperidone: a nested case–control study. Pharmacoepidemiol Drug Saf. 2010;19:881–8.

    Article  PubMed  Google Scholar 

  33. Sarna SK, Soergel KH, Koch TR, et al. Gastrointestinal motor effects of erythromycin in humans. Gastroenterology. 1991;101:1488–96.

    Article  CAS  PubMed  Google Scholar 

  34. Richards RD, Davenport K, McCallum RW. The treatment of idiopathic and diabetic gastroparesis with acute intravenous and chronic oral erythromycin. Am J Gastroenterol. 1993;88(2):203–7.

    CAS  PubMed  Google Scholar 

  35. Ray WA, Murray KT, Meredith S, Narasimhulu SS, Hall K, Stein CM. Oral erythromycin and the risk of sudden death from cardiac causes. N Engl J Med. 2004;351(11):1089–96.

    Article  CAS  PubMed  Google Scholar 

  36. Love BL, Johnson A, Smith LS. Linaclotide: a novel agent for chronic constipation and irritable bowel syndrome. Am J Health Syst Pharm. 2014;71(13):1081–91.

    Article  CAS  PubMed  Google Scholar 

  37. Forte LR. Guanyllin regulatory peptides: structures, biological activities mediated by cyclic gmp and pathobiology. Regul Pept. 1999;81:25–39.

    Article  CAS  PubMed  Google Scholar 

  38. SW Y, Rao SS. Advances in the management of constipation-predominant irritable bowel syndrome: the role of linaclotide. Therap Adv Gastroenterol. 2014;7(5):193–205.

    Article  Google Scholar 

  39. Lembo AJ, et al. Two randomized trials of Linaclotide for chronic constipation. NEJM. 2011;365:527–36.

    Article  CAS  PubMed  Google Scholar 

  40. Chey WD, et al. Linaclotide for irritable bowel syndrome with constipation: a 26 week randomized, double-blind, placebo controlled trial to evaluate efficacy and safety. Am J Gastroenterol. 2012;107:1702–12.

    Article  CAS  PubMed  Google Scholar 

  41. Hussain ZH, Everhart K, Lacy BE. Treatment of chronic constipation: prescrition medications and surgical therapies. Gastroenterol Hepatol. 2015;11(2):104–14.

    Google Scholar 

  42. Lacy BE, et al. Linaclotide in chronic idiopathic constipation patients with moderate to severe abdominal bloating: a randomized, controlled trial. PLoS One. 2015;10(7):e0134349.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Chey WD, Webster L, Sostek M, Lappalainen J, Barker PN, Tack J. Naloxegol for opioid induced constipation in patients with noncancer pain. NEJM. 2014;370(25):2387–96.

    Article  PubMed  Google Scholar 

  44. Garnock-Jones K. Naloxegol: a review of its use in patients with opioid-induced constipation. Drugs. 2015;75:419–25.

    Article  CAS  PubMed  Google Scholar 

  45. Webster L, Chey WD, Tack J, Lappalainen J, Diva U, Sostek M. Randomized clinical trial: the long-term safety and tolerability of naloxegol in patients with pain and opioid-induced constipation. Aliment Pharmacol Ther. 2014;409(7):771–19.

    Article  Google Scholar 

  46. Gottfridsson C, Carlson G, Lappalainen J, Sostek M. Evaluation of the effect of Naloxegol on cardiac repolarization: a randomized, placebo- and positive-controlled crossover thorough QT/QTc study in healthy volunteers. Clin Ther. 2013;35(12):1876–83.

    Article  CAS  PubMed  Google Scholar 

  47. Zachny JP, Wroblewski K, Coalson DW. Methylnaltrexone: its pharmacological effects alone and effects on morphine in healthy volunteers. Psychopharmacology. 2015;232:63–73.

    Article  Google Scholar 

  48. Candy B, Jones L, Goodman ML, et al. Laxatives or methylnaltrexone for the management of constipation in palliative care patients. Cochrane Database Syst Rev. 2011; doi:10.1002/14651858.

  49. Ford AC, Brenner DM, Schoenfeld PS. Efficacy of pharmacological therapies for the treatment of opioid-induced constipation; systematic review and meta-analysis. Am J Gastroenterol. 2013;108:1566–74.

    Article  CAS  PubMed  Google Scholar 

  50. Viscusi ER, Barrett AC, Peterson C, Forbes WP. Efficacy and safety of Methylnaltrexone for opioid-induced constipation in patients with chronic noncancer pain. Reg Anesth Pain Med. 2016;41(1):93–8.

    Article  CAS  PubMed  Google Scholar 

  51. Lee HK, Wang SC. Mechanisms of morphine-induced miosis in the dog. J Pharmacol Exp Ther. 1975;192:415–31.

    CAS  PubMed  Google Scholar 

  52. Stein C, Lan LJ. Peripheral mechanisms of opioid analgesia. Curr Opin Pharmacol. 2009;9(1):3–8.

    Article  CAS  PubMed  Google Scholar 

  53. Dutka J, Lowe SS, Michaud M, Watanabe S. Long-term use of methylnaltrexone for the management of constipation in advanced cancer. J Support Oncol. 2009;7:177.

    CAS  PubMed  Google Scholar 

  54. Slatkin NE, Lynn R, Su C, et al. Characterization of abdominal pain during methylnaltrexone treatment of opioid-induced constipation in advanced illness: a post hoc analysis of two clinical trials. J Pain Symptom Manage. 2011;42:754.

    Article  PubMed  Google Scholar 

  55. Wald, A. (n.d.). Treatment of irritable bowel syndrome in adults (NJ. Talley & S. Grover, Eds.). Retrieved from www.uptodate.com.

  56. Chang L, Chey WD, Harris L, et al. Incidence of ischemic colitis and serious complications of constipation among patients using alosetron: systematic review of clinical trials and post-marketing surveillance data. Am J Gastroenterol. 2006;101:1069.

    Article  PubMed  Google Scholar 

  57. Camilleri M, Northcutt AR, Kong S, et al. Efficacy and safety of alosetron in women with irritable bowel syndrome: a randomized, placebo-controlled trial. Lancet. 2000;355:1035.

    Article  CAS  PubMed  Google Scholar 

  58. Camilleri M. (n.d.). Alosetron hydrochloride (Lotronex) for irritable bowel syndrome (N.J. Talley & S. Grover, Eds.). Retrieved from www.uptodate.com.

  59. Tong K, Nicandro JP, Shringarpure R, et al. A 9-year evaluation of temporal trends in alosetron postmarketing safety under the risk management program. Therap Adv Gastroenterol. 2013;6:344.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Camilleri M, Chey WY, Mayer EA, et al. A randomized controlled clinical trial of the serotonin type 3 receptor antagonist alosetron in women with diarrhea-predominant irritable bowel syndrome. Arch Intern Med. 2001;161:1733.

    Article  CAS  PubMed  Google Scholar 

  61. Retrieved from Food and Drug Administration website: www.fda.gov.

  62. Lacy BE, Chey WD, Chang L. An evidence-based look at misconceptions in the treatment of patients with IBS-D. Gastroenterol Hepatol (N Y). 2013;9(11 Suppl 5):1–24.

    Google Scholar 

  63. Alosetron: DRUGEX Evaluations, Dosing/Administration. (n.d.). Retrieved from www.micromedexsolutions.com.

  64. Wilson N, Schey R. Lubiprostone in constipation: clinical evidence and place in therapy. Ther Adv Chronic Dis. 2015;6(2):40–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Lacy BE, Mearin F, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R. Bowel disorders. Gastroenterology. 2016;150:1393–407.

    Article  Google Scholar 

  66. Saha L. Irritable bowel syndrome: pathogenesis, diagnosis, treatment, and evidence-based medicine. World J Gastroenterol. 2014;20(22):6759–73.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Mearin F, Ciriza C, Minguez M, Rey E, Mascort J, Pena E, Canones P, Judez J. Clinical practice guideline: irritable bowel syndrome with constipation and functional constipation in the adult. Rev Esp Enferm Dig. 2016;108(6):332–63.

    PubMed  Google Scholar 

  68. Trinkley KE, Nahata MC. Medication management of irritable bowel syndrome. Digestion. 2014;89:253–67. doi:10.1159/000362405.

    Article  CAS  PubMed  Google Scholar 

  69. Lazaraki G, Chatzimavroudis G, Katsinelos P. Recent advances in pharmacological treatment of irritable bowel syndrome. World J Gastroenterol. 2014;20(27):8867–85.

    PubMed  PubMed Central  Google Scholar 

  70. Occhipinti K, Smith JW. Irritable bowel syndrome: a review and update. Clin Colon Rectal Surg. 2012;25(1):46–52. doi:10.1055/s-0032-1301759.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Page JG, Dirnberger GM. Treatment of the irritable bowel syndrome with Bentyl (dicyclomine hydrochloride). J Clin Gastroenterol. 1981;3:153–6.

    Article  CAS  PubMed  Google Scholar 

  72. Dicyclomine for gastrointestinal conditions: a review of the clinical effectiveness, safety, and guidelines. 03 Dec 2015. Retrieved from Canadian Agency for Drugs and Technologies in Health (www.cadth.ca).

  73. Martinez-Vazquez MA, Vazquez-Elizondo G, Gonzalez-Gonzalez JA, Gutierrez-Udave R, Maldonado-Garza HJ, Bosques-Padilla FJ. Effect of antispasmodic agents, alone or in combination, in the treatment of irritable bowel syndrome: systematic review and meta-analysis (review article). Rev Gastroenterol Mex. 2012;77(2):82–90.

    CAS  PubMed  Google Scholar 

  74. Wall GC, Bryant GA, Bottenberg MM, Maki ED, Miesner AR. Irritable bowel syndrome: a concise review of current treatment concepts. World J Gastroenterol. 2014;20(27):8796–806.

    PubMed  PubMed Central  Google Scholar 

  75. Rochon, PA., Sokol, HN. (n.d.). Drug prescribing for older adults (KE. Schmader, Ed.). Retrieved from www.uptodate.com.

  76. Lacy BE, Chey WD, Lembo AJ. New and emerging treatment options for irritable bowel syndrome. Gastroenterol Hepatol (N Y). 2015;2:1–19.

    Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Luis D. Lomeli M.D., Eric A. Gaumnitz M.D. & Mark Reichelderfer M.D.

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  1. Luis D. Lomeli M.D.
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  2. Eric A. Gaumnitz M.D.
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  3. Mark Reichelderfer M.D.
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Correspondence to Mark Reichelderfer M.D. .

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  1. Institute of Gastroenterology, Sheba medical Center, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel

    Eytan Bardan

  2. Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    Reza Shaker

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Lomeli, L.D., Gaumnitz, E.A., Reichelderfer, M. (2018). Top 10 Drugs Most Commonly Used for GI Motility Disorders. In: Bardan, E., Shaker, R. (eds) Gastrointestinal Motility Disorders . Springer, Cham. https://doi.org/10.1007/978-3-319-59352-4_39

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