Update from the Canadian Dyspepsia Working Group

In our recently published CMAJ supplement on the management of uninvestigated dyspepsia in the era of Helicobacter pylori,¹ we (on behalf of the Canadian Dyspepsia Working Group) made a very cautious statement about the use of cisapride, given the increasing number of publications that have recently described rare but potentially serious cardiac consequences associated with use of this drug. Cisapride was listed as a third option in the minimanagement schema for gastroesphageal reflux disease (Fig. 3)¹ and was also listed as a third option in the treatment schema for patients who have a negative result of noninvasive diagnostic testing for H. pylori. Given the cardiac side effects of cisapride use, both the Health Protection Branch and the US Food and Drug Administration have decided that cisapride should be withdrawn from the market and only released following special authorization for selected individuals. Given these recent changes in the availability of cisapride, the Canadian Dyspepsia Working Group feels that we can no longer recommend this medication for the treatment of gastroesophageal reflux disease or for the treatment of dyspepsia that is H. pylori negative.

Signatures

Sander J.O. Veldhuyzen van Zanten
Department of Medicine Dalhousie University Halifax, NS

Nigel Flook
Department of Family Medicine University of Alberta Edmonton, Alta.

Naoki Chiba
Division of Gastroenterology McMaster University Hamilton, Ont.

David Armstrong
Department of Medicine McMaster University Hamilton, Ont.

Alan Barkun
Department of Medicine McGill University Montreal, Que.

Marc Bradette
Department of Medicine Université Laval Quebec City, Que.

Alan Thomson
Department of Medicine University of Alberta Edmonton, Alta.

Ford Bursey
Health Sciences Centre Memorial University of Newfoundland St. John's, Nfld.

Patricia Blackshaw
Surrey Memorial Hospital Surrey, BC

Dawn Frail
College of Pharmacy Dalhousie University Halifax, NS

Paul Sinclair
AstraZeneca Canada Inc. Mississauga, Ont. for the Canadian Dyspepsia Working Group