Cimetidine, Metoclopramide, or Placebo in the Treatment of Symptomatic Gastroesophageal Reflux

We compared the effects of cimetidine, metoclopramide, and placebo in the short-term therapy of symptomatic gastroesophageal reflux in a placebo double-blind trial. Of 50 patients, 20 received cimetidine 300 mg, 20 received metoclopramide 10 mg, and 10 received placebo, all four times a day before meals and at bedtime. Patients followed other conventional therapy for gastroesophageal reflux. Before and at the end of the 8-week period, the esophagus was assessed endoscopically, its mucosal sensitivity was tested by a quantitative Bernstein test, and its mean resting lower sphincter pressure (LESP) was measured. We made frequent assessments of symptom severity, frequency of antacid usage, adverse effects, and laboratory studies. After 8 weeks, the percentage of patients with endoscopic improvement was slightly higher for metoclopramide-treated patients than for the others. LESP was not different for cimetidine, metoclopramide, or placebo patients and did not rise from low pretreatment values. Bernstein tests showed mucosai sensitivity had not altered in cimetidine or metoclopramide patients. A significant number of patients who were taking cimetidine or metoclopramide, however, had less pain than before. Although antacid usage decreased in all three groups, it was significantly lower only in patients treated with cimetidine or metoclopramide. There were no laboratory abnormalities. Six of 20 patients taking metoclopramide reported neurologic and psychotropic symptoms such as drowsiness, lethargy and hyperactivity; three withdrew after 48 hours, one had acute torticollis, and of the remaining three, two became depressed. Cimetidine or metoclopramide is therefore more effective than placebo for the relief of symptoms of gastroesophageal reflux disease, but metoclopramide is attended by significant side effects.