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Meta-Analysis
. 2010 Apr 14;2010(4):CD002300.
doi: 10.1002/14651858.CD002300.pub2.

Cisapride treatment for gastro-oesophageal reflux in children

Suzanna Maclennan  1 , Cristina Augood, Lucinda Cash-Gibson, Stuart Logan, Ruth E Gilbert
Affiliations
Meta-Analysis

Cisapride treatment for gastro-oesophageal reflux in children

Suzanna Maclennan et al. Cochrane Database Syst Rev. .

Abstract

Background: Gastro-oesophageal reflux (GOR) is common and usually self-limiting in infants. Cisapride, a pro-kinetic agent, was commonly prescribed until reports of possible serious adverse events were associated with its use.

Objectives: To determine the effectiveness of cisapride versus placebo or non-surgical treatments for symptoms of GOR.

Search strategy: We searched the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Specialised Register and Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, reference lists of relevant review articles and searched in the Science Citation Index for all the trials identified. All searches were updated in February 2009.

Selection criteria: Randomised controlled trials comparing oral cisapride therapy with placebo or other non-surgical treatments for children diagnosed with GOR were included. We excluded trials with a majority of participants less than 28 days of age.

Data collection and analysis: Primary outcomes were a change in symptoms at the end of treatment, presence of adverse events, occurrence of clinical complications and weight gain. Secondary outcomes included physiological measures of GOR or histological evidence of oesophagitis. We dichotomised symptoms into 'same or worse' versus 'improved' and calculated summary odds ratios (OR). Continuous measures of GOR (for example reflux index) were summarised as a weighted mean difference. All outcomes were analysed using a random-effects method.

Main results: Ten trials in total met the inclusion criteria. Nine trials compared cisapride with placebo or no treatment, of which eight (262 participants) reported data on symptoms of gastro-oesophageal reflux. There was no statistically significant difference between the two interventions (OR 0.34; 95% CI 0.10 to 1.19) for 'same or worse' versus 'improved symptoms' at the end of treatment. There was significant heterogeneity between the studies, suggesting publication bias. Four studies reported adverse events (mainly diarrhoea); this difference was not statistically significant (OR 1.80; 95% CI 0.87 to 3.70). Another trial found no difference in the electrocardiographic QTc interval after three to eight weeks of treatment. Cisapride significantly reduced the reflux index (weighted mean difference -6.49; 95% CI -10.13 to -2.85; P = 0.0005). Other measures of oesophageal pH monitoring did not reach significance. One included study compared cisapride with Gaviscon (with no statistically significant difference). One small study found no evidence of benefit on frequency of regurgitation or weight gain after treatment with cisapride versus no treatment, carob bean or corn syrup thickeners.

Authors' conclusions: We found no clear evidence that cisapride reduces symptoms of GOR. Due to reports of fatal cardiac arrhythmias or sudden death, from July 2000 in the USA and Europe cisapride was restricted to a limited access programme supervised by a paediatric gastrologist.

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Conflict of interest statement

None known

Figures

1
1
Funnel plot of comparison: 1 Main analysis for cisapride versus no treatment, outcome: 1.1 'Worse, same or slight improvement' versus 'moderate or excellent improvement'.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 Main analysis for cisapride versus no treatment, Outcome 1 'Worse, same or slight improvement' versus 'moderate or excellent improvement'.
1.2
1.2. Analysis
Comparison 1 Main analysis for cisapride versus no treatment, Outcome 2 Mean daily regurgitations.
1.3
1.3. Analysis
Comparison 1 Main analysis for cisapride versus no treatment, Outcome 3 Mean daily weight gain.
1.4
1.4. Analysis
Comparison 1 Main analysis for cisapride versus no treatment, Outcome 4 Reflux index.
1.5
1.5. Analysis
Comparison 1 Main analysis for cisapride versus no treatment, Outcome 5 Adverse events.
2.1
2.1. Analysis
Comparison 2 Main analysis for cisapride versus Gaviscon, Outcome 1 'Worse, same or slight improvement' versus 'moderate or excellent improvement'.
3.2
3.2. Analysis
Comparison 3 Main analysis for cisapride versus dietary interventions, Outcome 2 Carob bean: mean daily regurgitations.
3.3
3.3. Analysis
Comparison 3 Main analysis for cisapride versus dietary interventions, Outcome 3 Carob bean: mean daily weight gain.
3.4
3.4. Analysis
Comparison 3 Main analysis for cisapride versus dietary interventions, Outcome 4 Corn syrup: mean daily regurgitations.
3.5
3.5. Analysis
Comparison 3 Main analysis for cisapride versus dietary interventions, Outcome 5 Corn syrup: mean daily weight gain.
4.1
4.1. Analysis
Comparison 4 Sensitivity analyses for cisapride versus no treatment, Outcome 1 Best case scenario.
4.2
4.2. Analysis
Comparison 4 Sensitivity analyses for cisapride versus no treatment, Outcome 2 Worst case scenario.
4.3
4.3. Analysis
Comparison 4 Sensitivity analyses for cisapride versus no treatment, Outcome 3 Change in outcome definition: 'any symptoms' vs 'no symptoms' at end of treatment.
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References

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MeSH terms