PTU-026 The use of domperidone as a prokinetic in video capsule endoscopy

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Abstract

Introduction

Domperidone is thought to accelerate gastric emptying through its action on the D2 receptors at the gastro-oesophageal and gastro-duodenal junctions. It is currently listed in the BNF as a prokinetic anti-emetic and has been used for this purpose in clinical practice for several years. This belief led to its use during video capsule endoscopy (VCE), to accelerate capsule delivery to the small intestine and reduce the risk of an incomplete VCE. Here we audited VCEs performed in our department from 2011, when domperidone was given pre-VCE as standard practice, and 2012, when domperidone use was discontinued due to doubts as to its effectiveness.

Method

Thirty-one consecutive patients were pre-treated with domperidone 20 mg orally just before a VCE study. We then assessed a further 33 patients who underwent VCE without domperidone pre-treatment.

Method

The VCE was done with the GIVEN capsule using the RAPID 6 software. Oro-pyloric transit time and oro-caecal transit time were calculated. If after 2 hours the capsule was still in the stomach a gastroscopy was performed to deliver it into the duodenum. Data was analysed using the Mann-Whitney test.

Results

There were 13 and 17 males in the untreated and domperidone groups respectively. The median age was 55 and 59 years in the untreated and domperidone groups respectively.

Results

The median oro-pyloric transit time was 13 min (range 4–78 min) in the untreated group and increased to 30 min (2–120 min) (p=0.01) in the domperidone group. Median oro-caecal transit time was 242 min (76–457 min) in the untreated group and increased to 267 min (163–846 min) (p=0.02) in the domperidone group. There was no difference in pyloro-caecal transit in both groups (p=0.60).

Results

6% (2/34) in the untreated group and 13% (4/31) of the domperidone group required gastroscopy assisted capsule delivery to the duodenum (p=0.65). VCE was completed in all untreated patients compared to 97% of the domperidone group. Clinically significant findings were reported in 9/33 of the untreated group and 5/31 of the domperidone group.

Conclusion

Unexpectedly we find that domperidone delays VCE transit through the stomach in humans. Although the oro-caecal time is also increased in patients pre-treated with domperidone this is almost entirely due to its effect on the foregut. Most studies into the prokinetic effects of domperidone have been on gastroparesis in diabetic patients. These have shown that whilst domperidone can achieve good symptomatic relief, it only improved gastric emptying in 27%–37% (1). Our study suggests that any anti-emetic effect of domperidone is not mediated through acceleration in gastric transit.

Disclosure of Interest

None Declared

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