Use of Cisapride in Treatment of Idiopathic Constipation in Children

To the Editor: I read with interest the comprehensive review of cisapride therapy for gastrointestinal disease by Cucchiara (1). On the problem of constipation, there were several studies carried out in adults that were discussed and only a few paediatric studies. Of the paediatric studies, an open trial by Murray et al. (2) failed to show any significant increase in stool frequency in spite of their use of generous doses of cisapride. Staiano et al. (3), using a double-blind approach, studied 20 children given a cisapride dose of 0.6 mg/kg/day and recorded a significant increase in stool frequency and reduced gastrointestinal transit time. At our paediatric gastroenterology unit, we studied the effect of the use of cisapride for the management of constipation. Thirty-seven children with idiopathic constipation of >3 months' duration were recruited to the 10-week study. After an initial run-in period of 2 weeks, they were randomised in double-blinded, parallel-group format to receiving placebo or cisapride (0.6 mg/kg/day). Thirty patients completed the trial. Transit studies were carried out at entry to treatment phase (week 3) and at the end of the treatment phase (week 10). Stool frequency was also recorded throughout the 10-week period. Compared with placebo, cisapride did not improve either stool frequency or transit time in the study population. Our study did not demonstrate a clinical role for cisapride in the treatment of idiopathic constipation of childhood. E. B. Odeka; V. Miller Department of Paediatric Gastroenterology; Manchester Children's Hospital; Manchester, United Kingdom