Prucalopride curbs ileus after GI surgery

Last Updated: 2016-03-10

By David Douglas

NEW YORK (Reuters Health) - Oral prucalopride after elective gastrointestinal surgery reduces the time to first bowel movement and shortens postoperative hospital stay, according to Chinese researchers.

"Postoperative recovery and hospital discharge after abdominal surgery is often delayed by intestinal ileus," Dr. Weiming Zhu of the Medical School of Nanjing University told Reuters Health by email. "Prucalopride, a drug commonly used for constipation, shortened the duration of ileus."

In their report, online February 15 in Alimentary Pharmacology and Therapeutics, Dr. Zhu and colleagues note that recent evidence suggests recovery of colonic transit, but not gastric emptying, is significantly correlated with clinical recovery of gastrointestinal motility in patients with postoperative ileus (POI). Prucalopride accelerates colonic transit and thus may reduce POI.

To investigate, the researchers randomized 110 patients to receive either oral prucalopride 2 mg per day or placebo starting 24 hours after undergoing elective gastrointestinal surgery. Treatment was stopped after first bowel movement or a maximum of seven days.

The active-treatment group had a significantly shorter time to defecation (65.0 vs. 94.5 hours). This was also true of passage of flatus (53.0 vs. 73.0 hours) and length of hospital stay (7.0 vs. 8.0 days).

The proportion of patients with ileus beyond five days was also significantly smaller (16.4% vs. 34.5%), as was the degree of inflammation as measured by C-reactive protein levels at five days postoperatively (35.67 vs. 59.07 mg/L).

There were no significant between-group differences in overall postoperative complications, Clavien-Dindo grade III or IV complications, or surgical site infection. There was also a trend towards more anastomotic leakage in control patients. This was seen in five (9.1%) in this group compared to none in the prucalopride group.

The researchers conclude that prucalopride is a safe and effective treatment in these patients, but they call for further studies to validate and generalize their findings.

Commenting on the findings by email, Dr. Ian Bissett, professor and consultant colorectal surgeon at the University of Auckland, New Zealand, told Reuters Health, "The study has shown a significant shortening of the time to first bowel motion and a decrease in post-operative hospital stay by one day."

"Unfortunately," he added, "there was no reduction in time to first solid food. There was also a decrease in the incidence of prolonged postoperative ileus using a well-recognised definition. It is unclear whether the research nurse was blinded to the intervention group of the patient and this may represent a possible cause of bias."

Nevertheless, Dr. Bissett concluded that, "This study presents an exciting new use for prucalopride as a preventative measure in prolonged post-operative ileus."

The study did not have commercial funding and the researchers declared no conflicts of interest.

SOURCE: bit.ly/1UgYSEL

Aliment Pharmacol Ther 2016.