A Vision for Hope:
A Western Canadian Neuro-enteric Research Centre and Gastrointestinal Motility Centre of Excellence -- the dream is now reality!

It is now official: March 2008: The University of Calgary has created a special fund to support the first:

Centre for Digestive Motility

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News on latest pharmacological approvals, suspensions, and diagnostics:

• Tegaserod (Zelnorm), used for the treatment of IBS-C drug is no longer available in the United States under an  investigational new drug protocol (IND). However, the emergency access program remains in place, permitting use for symptomatic women younger than 55 in "critical need". Tegaserod remains unavailable in Canada.

• Lubiprostone (Amitiza), has been available in the United States for the treatment of chronic idiopathic constipation, and has now also recently been approved by the FDA for the treatment of  IBS-C. Common side-effects include, nausea, diarrhea and abdominal pain -- so may only be of limited use for individuals with upper-gut motor disturbances (like gastroparesis) who also suffer slow-transit (idiopathic) constipation.

• Methylnaltrexone, has just been submitted to the FDA for an NDA (new drug application) approval. Methyltrexone, delivered by subcutaneous injection,  is a peripherally acting mu opioid-receptor antagonist, and is designed to treat opioid induced constipation without interfering with pain relief. In otherwords, persciption morphine and morphine-like pain medications will provide pain releif but have their side-effect of constipation blocked by methylnaltrexone. Not the first drug in its class, methylnaltrexone was proceeded by alvimopan (Entereg), another peripheral acting mu-opioid antagonist seeking an NDA by the FDA for the treatment of post-operative ileus (when bowel motility shuts-down because of anesthetic effects of surgery). In 2007 Entereg clinical trials were suspended due to cardiovascular concerns. Why is this class of drugs exciting to watch? Drugs in this class (mu-opioid antagonists) have been demonstrated to have pro-motility effects -- helping improve the motor action within the lower regions of the stomach (antrum) and helping to enhance motility in the small bowel and colon. Many patients with gastroparesis need opioids to control abdominal pain--vastly complicating and further slowing their already slow gut -- now there is hope for more treatment options.

• The SmartPill, by Smart Pill Corporation is licensed for use in Canada and the United States. The SmartPill Capsule is about the same size as a large vitamin. It is a wireless, medical device  that measures pressure and pH, gastric emptying time, combined small and large bowel transit time, and total transit time--thus providing a wealth of information related to gut motility and pH. The pill is swallowed in the physician's office then it begins transmitting data on its journey through the digestive tract to the SmartPill Data Receiver. The Receiver, slightly larger than a cell phone, is worn on a belt or slung around the neck. The pill is expelled days later and returned to the doctor's office.

• Metoclopramide (Maxeran, Reglan), just published in the Journal of Clinical Pharmocology, 2008;48:379-384, reports that in nearly 40% of individuals taking metocloprimide, were found to have developed a very serious and chronic momement disorder called tardive dyskinesia (TD).  Many people with gastroparesis (including children with gastroeophageal reflux) are perscribed metoclopramide. Metoclopramide causes TD and the risk of TD increases with duration of drug use. People with GP and reflux problems may need mediations for years. Stelazine -- another popular anti-nauseant drug used in Canada, was also found in this same study to be associated with TD in over 11% of the people taking it. Again, people with GP often need medications for years -- stelazine is not appropriate in these cases, nor is metoclopraimide -- the risks exceed any benefits.