In a healthy human esophagus, swallowing induces primary peristalsis. These are the contractions that move your food down your esophagus and through the rest of your digestive system. In turn, gastroesophageal reflux provokes a second wave of muscular contractions that clears the esophagus, pushing food down through the lower esophageal sphincter (LES) and into the stomach. However, in some people, the LES either relaxes or opens spontaneously, allowing stomach contents, including acids, to reenter the esophagus. This is called acid reflux and may lead to symptoms like heartburn. Prokinetic agents, or prokinetics, are medications that help control acid reflux. Prokinetics help strengthen the lower esophageal sphincter (LES) and cause the contents of the stomach to empty faster. This allows less time for acid reflux to occur. Today, prokinetics are typically used with other gastroesophageal reflux disease (GERD) or heartburn medications, such as proton pump inhibitors (PPIs) or H2 receptor blockers. Unlike these other acid reflux medications, which are generally safe, prokinetics may have serious, or even dangerous, side effects. They’re often only used in the most serious cases of GERD. For example, prokinetics might be used to treat people who also have insulin-dependent diabetes, or infants and children with significantly impaired bowel emptying or severe constipation that doesn’t respond to other treatments.
Types of Prokinetic Agents
Bethanechol (Urecholine) is a medication that stimulates the bladder and helps you pass urine if you are having trouble emptying your bladder. It helps strengthen the LES, and makes the stomach empty faster. It also helps prevent nausea and vomiting. It is available in tablet form. However, its usefulness may be outweighed by frequent side effects. Its side effects can include:
- physical problems such as involuntary movements and muscle spasms
Cisapride (Propulsid) acts on serotonin receptors in the stomach. It was primarily used to improve muscle tone in the LES. However, because of its side effects, such as irregular heartbeat, it has been removed from the market in several countries, including the United States. It was once considered as effective in treating GERD as H2 receptor blockers such as famotidine (Pepcid). Cisapride is still often used in veterinary medicine.
Metoclopramide (Reglan) is a prokinetic agent that has been used to treat GERD by improving muscle action in the gastrointestinal tract. It’s available in both tablet and liquid forms. Like other prokinetics, metoclopramide’s efficacy is hindered by serious side effects. Side effects may include an increased risk of neurological conditions such as tardive dyskinesia, which causes involuntary repetitive movements. These side effects have been known to occur in people who remain on the drug for more than three months. People taking metoclopramide should be extremely cautious while driving or operating heavy machinery or equipment. Work with your doctor to figure out which treatment plan is right for you. Make sure you follow the directions your doctor gives you. Call your doctor if you feel like your medications have caused negative side effects.