Background Domperidone is widely used for the management of symptoms in patients with Systemic Sclerosis (SSc) and esophageal involvement, but its efficacy is under question. Recently, buspirone, an orally available 5-HT1A receptor agonist, was shown to enhance esophageal peristalsis and lower esophageal sphincter (LES) function in healthy volunteers (Di Stefano M et al, Dis Esophagus. 2012 Jul;25(5):470-6)
Objectives To evaluate the effects of acute buspirone and domperidone administration in SSc patients with symptomatic esophageal involvement.
Methods Thirty consecutive patients (26 women, aged 52.3±10.4 years, 15 and 15 with diffuse or limited SSc, respectively) underwent high resolution esophageal manometry (HRM) before and 30 minutes after randomised administration of 10 mg buspirone (n=19) or 10 mg domperidone (n=11). We compared buspirone and domperidone effects, before and after drug administration, on: a) resting pressure of the LES; b) residual pressure of LES relaxation; c) amplitude, duration, and onset velocity of esophageal body contractions. Prior to HRM each patient completed a self-reported 0-100 visual analogue scale questionnaire for esophageal symptoms (ESQ).
Results There was no difference in terms of SSc characteristics, as well as of clinical severity (assessed by ESQ scores) and extent (assessed by HRM findings) of esophageal involvement between patients who received buspirone or domperidone. Buspirone increased mean resting pressure of LES (from 9.42±2.6 to 11.53±3.4 p<0.001 by paired t-test), whereas domperidone’s effect was not significant (from 9.09±3 to 8.64±2.6, p=0.469). Comparison of the mean individual changes after administration of either drug revealed that buspirone was superior to domperidone in enhancing the resting pressure of LES ( +2.11±2.0 versus -0.45±2.3, p=0.006 ). Neither buspirone nor domperidone had any significant effect on the other examined parameters of esophageal function.
Conclusions Acute administration of buspirone, but not of domperidone, exerted a beneficial effect on impaired LES function in patients with SSc, suggesting a role of 5-HT1A receptor-mediated interactions in these patients. Prospective studies to examine whether buspirone is of long-term therapeutic value for SSc-associated esophageal disease are warranted.
Disclosure of Interest: None Declared