Be sure to tell your doctor and pharmacist about all the products you use including prescription drugs , nonprescription drugs, and herbal products. If heartburn only occurs at certain times such as after the evening meal , your doctor may direct you to take a single dose before those times instead of taking it throughout the day.

This will reduce your risk of side effects. Because of the risk of tardive dyskinesia , do not take this more often, in larger doses, or for longer than directed by your doctor.

According to the manufacturer, treatment should not exceed 12 weeks. Individuals with CIP due to abnormalities of these cells have signs of both muscle and nerve disease in the GI tract. Examination of tissue from the gut of patients with CIP showed that commonly, both the muscle and nerves are affected by the disease process.

Affected Populations CIP affects males and females in equal numbers and can affect individuals of any age. The prevalence of CIP in the general population is unknown. According to some sources approximately new cases of CIP are reported in children in the United States each year. However, CIP often goes unrecognized or misdiagnosed making it extremely difficult to determine the true frequency of CIP in the general population.

Children are predominantly affected by primary, non-familial, sporadic CIP. Adults are generally affected by secondary CIP, most often due to systemic diseases such as scleroderma, diabetes, or paraneoplastic syndromes. Comparisons may be useful for a differential diagnosis.

The signs and symptoms of mechanical obstruction of the GI tract are virtually indistinguishable from those associated with CIP. Such symptoms include abdominal pain and bloating, nausea and vomiting and constipation. Mechanical obstruction can be caused by a variety of conditions including adhesions scar tissue , foreign ingested material, gallstones, tumors, hernia, abnormal tissue growth, twisting of a loop of the intestines back around itself volvulus , and intussusception, a condition in which one portion of the intestines slides into another much like a collapsing telescope.

It is extremely important to distinguish CIP from mechanical obstruction of the GI tract as the underlying process and potential treatments are different. Ogilvie syndrome, also known as acute colonic pseudo-obstruction, is a rare disorder characterized by abnormalities affecting the involuntary, rhythmic muscular contractions a process called peristalsis within the colon of the large intestines. Peristalsis propels food and other material through the digestive system through the coordination of muscles, nerves and hormones.

Symptoms are similar to other forms of intestinal pseudo-obstruction and can include nausea, vomiting, abdominal bloating or swelling and constipation. The symptoms of Ogilvie syndrome mimic those of a mechanical obstruction of the colon, but no such physical obstruction is present. Ogilvie syndrome is usually associated with an underlying disorder or due to trauma or surgery. A variety of gastrointestinal disorders can have signs and symptoms that are similar to those seen in CIP. For more information on these disorders, choose the specific disorder name as your search term in the Rare Disease Database.

Diagnosis A diagnosis of CIP is made based upon identification of characteristic symptoms, a detailed patient history, a thorough clinical evaluation and a variety of specialized tests to rule out other conditions or identify underlying causes. Clinical Testing and Work-Up A variety of laboratory tests may be performed such as a complete blood count to check for anemia or infection; erythrocyte sedimentation SED rate, which measures how much inflammation is in the body; tests to determine the levels of serum electrolyte, thyroid hormone levels, and albumin; tests to determine how long it takes the blood to clot, which can be abnormal in individuals with bacterial overgrowth or significant nutritional deficiencies; and certain antibody tests that can be used to rule out other conditions or identify underlying causes of CIP.

CIP is virtually indistinguishable from mechanical obstruction based solely on signs and symptoms. X-ray examination of the GI tract will be performed to rule out mechanical obstruction. Plain abdominal films can reveal widened distended bowel loops and air-fluid levels, which may also be present in intestinal obstruction and are necessary for a diagnosis of CIP. If such evidence of obstruction is found, a barium contrast study is usually performed on the entire GI tract to help rule out or identify a mechanical obstruction.

Barium studies can also reveal absent or abnormal peristalsis. Ruling out short bowel obstruction is the most important distinction to make when diagnosing CIP. The finding that metoclopramide releases catecholamines in patients with essential hypertension suggests that it should be used cautiously, if at all, in patients receiving monoamine oxidase inhibitors.

Absorption of drugs from the stomach may be diminished e. Gastroparesis gastric stasis may be responsible for poor diabetic control in some patients. Exogenously administered insulin may begin to act before food has left the stomach and lead to hypoglycemia. Because the action of metoclopramide will influence the delivery of food to the intestines and thus the rate of absorption, insulin dosage or timing of dosage may require adjustment.

Symptoms have ranged from mild to severe and have included suicidal ideation and suicide. Metoclopramide should be given to patients with a prior history of depression only if the expected benefits outweigh the potential risks. These usually are seen during the first 24 to 48 hours of treatment with metoclopramide, occur more frequently in pediatric patients and adult patients less than 30 years of age and are even more frequent at higher doses.

These symptoms may include involuntary movements of limbs and facial grimacing, torticollis , oculogyric crisis, rhythmic protrusion of tongue, bulbar type of speech, trismus , or dystonic reactions resembling tetanus. Rarely, dystonic reactions may present as stridor and dyspnea , possibly due to laryngospasm. If these symptoms should occur, inject 50 mg diphenhydramine hydrochloride intramuscularly, and they usually will subside.

Benztropine mesylate, 1 to 2 mg intramuscularly, may also be used to reverse these reactions. Parkinsonian-like symptoms have occurred, more commonly within the first 6 months after beginning treatment with metoclopramide, but occasionally after longer periods.

These symptoms generally subside within 2 to 3 months following discontinuance of metoclopramide. The risk of developing tardive dyskinesia increases with the duration of treatment and the total cumulative dose. Treatment with metoclopramide for longer than the recommended 12 weeks should be avoided in all but rare cases where therapeutic benefit is thought to outweigh the risk of developing TD. Although the risk of developing TD in the general population may be increased among the elderly, women, and diabetics, it is not possible to predict which patients will develop metoclopramide-induced TD.

Both the risk of developing TD and the likelihood that TD will become irreversible increase with duration of treatment and total cumulative dose. Metoclopramide should be discontinued in patients who develop signs or symptoms of TD. There is no known effective treatment for established cases of TD, although in some patients, TD may remit, partially or completely, within several weeks to months after metoclopramide is withdrawn.

Metoclopramide itself may suppress, or partially suppress, the signs of TD, thereby masking the underlying disease process. Decreased interstitial cell of cajal volume in patients with slow-transit constipation. Interstitial cells of Cajal at the clinical and scientific interface. Treatment of abdominal pain in irritable bowel syndrome.

Transplanted progenitors generate functional enteric neurons in the postnatal colon. Karamanolis G, Tack J. Promotility medications--now and in the future. Molecular, functional, and pharmacological targets for the development of gut promotility drugs.

Drugs that increase the propulsive force of the intestines have been tried, as have different types of surgery. Medical treatment[ edit ] Prucalopride , [10] [11] pyridostigmine , [3] metoclopramide , cisapride , and erythromycin may be used, but they have not been shown to have great efficacy. In such cases, treatment is aimed at managing the complications. Linaclotide is a new drug that received approval from Food and Drug Administration in August and looks promising in the treatment of chronic intestinal pseudo-obstruction, gastroparesis and inertia coli.

Nutritional deficiencies are treated by encouraging patients to avoid food high in fat and fibre, which are harder to digest and increase abdominal distention and discomfort, and have small, frequent meals 5—6 per day , focusing on liquids and soft food.

Because of its favorable safety profile, domperidone appears to be an attractive alternative to metoclopramide. Macrolide antibiotics, including erythromycin and clarithromycin, are motilin receptor agonists. They also appear to stimulate cholinergic and noncholinergic neuronal pathways to stimulate motility.

Erythromycin has been effective in the treatment of gastroparesis in human patients in whom metoclopramide or domperidone was ineffective. Erythromycin increases the gastric emptying rate in healthy dogs, but large food chunks may enter the small intestine and be inadequately digested.

Erythromycin induces contractions from the stomach to the terminal ileum and proximal colon, but the colon contractions do not appear to result in propulsive motility. Therefore, erythromycin is unlikely to benefit patients with colonic motility disorders. Human pharmacokinetic studies indicate that erythromycin suspension is the ideal dosage form for administration of erythromycin as a prokinetic agent.

Other macrolide antibiotics have prokinetic activity with fewer adverse effects than erythromycin and may be suitable for use in small animals. Both erythromycin and clarithromycin are metabolized by the hepatic cytochrome P enzyme system and inhibit the hepatic metabolism of other drugs, including theophylline, cyclosporine, and cisapride.

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