New Hope for Gastroparesis
Gastroparesis is a motility disorder affecting 4% of Canadians. It occurs when food does not move from the stomach into the intestine as quickly as it should, usually due to damage to, or impaired function of, the nerves connecting the brainstem to the gastrointestinal tract (vagus nerve). Symptoms include feeling excessively full, heartburn, nausea, vomiting, abdominal pain, bloating, and more.
Management of gastroparesis consists of lifestyle and dietary modifications, which are only minimally helpful, and medications that help to alleviate some symptoms, but don’t treat the underlying condition.
Researchers in Korea1 analyzed two recent small studies and reported on the effectiveness of prucalopride (Resotran®), an oral medication used for chronic constipation, as a potential treatment for gastroparesis.
Health Canada approved prucalopride in 2012 as a second-line treatment for chronic constipation of unknown cause (idiopathic) in adult females. It is a prokinetic agent that improves gastrointestinal motility by increasing the frequency or strength of intestinal contractions, without disrupting their rhythm. It alleviates infrequent bowel movements that produce hard, lumpy, dry stool, and also relieves bloating and abdominal pain.
Prucalopride works for chronic constipation by targeting the serotonin (5-HT4) receptors in the digestive tract to stimulate muscle movement (motility), usually activating a bowel movement within two to three hours. Regular, spontaneous complete bowel movements then typically occur within four to five days of starting treatment.
The authors examined two randomized controlled crossover pilot trials. In one study done in Canada in 2020 with 15 individuals who had diabetic gastroparesis and gastroparesis caused by connective tissue disease, participants reported enhanced gastric emptying while using prucalopride. In the other trial, done in Belgium in 2019 with 34 participants who had diabetic gastroparesis and idiopathic gastroparesis, a daily 2 mg dose of prucalopride over four weeks showed improvements in symptoms of nausea, vomiting, fullness, bloating, and abdominal pain. Both studies had a majority of female participants.
Interestingly, the study authors found no significant connection between the gastric emptying rate and symptom improvement. It appears that the therapeutic benefit of prucalopride might not be entirely due to its prokinetic effect but to other mechanisms as well, such as its antinociceptive effect, which increases a person’s tolerance to the pain of gas passing through the intestinal tract. The authors suggest that further research should analyze this mechanism and note that other studies also reported that prucalopride led to significant improvements in bloating and quality of life.
Side effects of prucalopride for some patients included diarrhea, headache, abdominal cramps, bladder infection (cystitis), and respiratory infection; however, these were temporary and typically occurred within the first 24 hours after taking the drug.
Prucalopride leaves the body through urine, so it is contraindicated for dialysis patients. It is also contraindicated for individuals with a history of intestinal obstruction, drug sensitization, toxic megacolon, or if pregnant or lactating.
This analysis, although small, provides hope that prucalopride could relieve the underlying factors of gastroparesis and help with symptoms. Gastroparesis is often present among those with chronic constipation so individuals with both conditions might also benefit.
The authors recommend more studies on the long-term effectiveness of prucalopride, since a few trial participants reported a decrease in symptom improvement over time, which might be due to the development of drug tolerance (tachyphylaxis). However, a drug holiday, during which a person stops taking a medication for two to four weeks, can usually resolve this.
Consult your doctor for more information.