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| |  DDW: Migraine Drug, Sumatriptan, Shown Effective For Intestinal Dysmotility By Bruce Wilson Special to DG News ATLANTA, GA -- May 21, 2001 -- Sumatriptan, an effective treatment for migraine, has been demonstrated to stimulate gastrointestinal (GI) motility in patients with intestinal dysmotility. More than half of patients visiting a gastroenterologist complain of this condition, said Carole Mathis, PhD, a post-doctoral fellow at Johns Hopkins University, Baltimore, Maryland, who presented her study at the Digestive Disease Week meeting in Atlanta, Georgia. Dr. Mathis said that migraine patients often experience GI symptoms. This led researchers to question whether there may be a common mechanism in the two disorders. In work with healthy volunteers, it was found that sumatriptan, a 5HT1p-receptor agonist, modifies interdigestive GI motility by inducing premature small intestinal phase III activity while suppressing gastric phase III activity. Dr. Mathis and her associates enrolled 13 patients with upper GI motility and/or transit dysfunction who complained of nausea, vomiting, and early satiety and treated them with either sumatriptan (6 mg s.c.) or erythromycin (50 mg IV), a well-known motility stimulant. Gastric and duodenal motility in the patients was measured with a manometry catheter. The motility activity front propagated normally into the duodenum in 10 patients. After sumatriptan, antral activity was completely suppressed in eight patients, inhibited in three, and stimulated in two. In the duodenum, sumatriptan induced a normally propagated phase III activity front with contractions of amplitude and frequency similar to the erythromycin-induced phase III in all patients. Discussing the results, Dr. Mathis said, "we had two different populations, according to their response to sumatriptan. Some patients had a normal expected response, which was inhibition of antral contractions with stimulation of duodenal motility. In the other population, sumatriptan did not do anything." She noted that although the reason for this difference in response is not known at present, the study does reveal that sumatriptan may be an effective agent in some patients with motility dysfunction. Positing a mechanism for sumatriptan in the intestine, Dr. Mathis said, "the effect on the antrum could be due to nitrous oxide release due to 5HT-1 activation. Others might suggest that it might be related to an effect on motilin." Research on the mechanism of sumatriptan in the gut is currently active.
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