Effect of metoclopramide on normal and delayed gastric emptying in gastroesophageal reflux patients

Gastric emptying has an important role in the pathophysiology of gastroesophageal reflux disease. We investigated the effect of metoclopramide, a gastric prokinetic agent, in gastroesophageal reflux patients with normal as well as delayed emptying. Twenty-six patients with subjective and objective evidence of gastroesophageal reflux ingested an egg salad sandwich meal labeled with^99mtechnetium-DTPA for a baseline study, and then again on a separate day after receiving oral metoclopramide, 10 mg, 30 min prior to the test meal. The mean percent isotope remaining in the stomach after 90 min improved significantly (P<0.001) from 70.3±3.9% (sem) to 55.2±4.2% after metoclopramide. Fourteen (54%) had a basal emptying in the normal range of 34–69% retention of isotope at 90 min,\((\bar X \pm 2SD)\), while it was slow in 12 (46%). For those with delayed basal gastric emptying, the mean retention of 88.9±2.9% at 90 min was significantly (P<0.005) decreased by metoclopramide to 68.6±6.1%. In those patients with a normal basal gastric emptying and a mean retention of 54.4±2.3% at 90 min, there was also significant improvement (P<0.025) to 43.6±3.6% after metoclopramide. These data indicate that metoclopramide increased gastric emptying in gastroesophageal reflux patients with normal as well as delayed gastric emptying. Therefore on a patient management level a trial of metoclopramide is warranted in patients with gastroesophageal reflux disease and is not limited by the gastric emptying status of the patient.