Prokinetic therapy for gastroenterological diseases

Normal propulsion of luminal contents through the gastrointestinal (GI) tract requires complex, coordinated neural and motor activity. Abnormalities can occur at a number of different levels, and there are numerous etiologies. Several drugs are proven to be effective in stimulating the motility of the GI tract. The most common medications used in the USA are erythromycin, metoclopramide, and neostigmine. A new prokinetic agent, tegaserod, has been recently approved, and other serotonin agonist agents are currently undergoing clinical studies. Cisapride has been withdrawn from the market because of its side-effects. Other prokinetics, such as domperidone, are not yet approved in the USA, although it is used in other countries. This review summarizes current knowledge of the mechanisms of GI motility disorders, as well as new agents that show promise as therapy.