Prokinetic Selection for Postprandial Distress Syndrome (PDS)

Introduction to Prokinetic Options

The British Society of Gastroenterology recommends acotiamide and itopride as interchangeable first-line prokinetic options with weak recommendations and low-quality evidence, while cintapride has a favorable safety profile but lacks direct comparative data 1, 2, 3

The British Society of Gastroenterology guidelines state that prokinetics may be efficacious for functional dyspepsia, with acotiamide and itopride having weak recommendations with low-quality evidence 1, 2, 3
Tegaserod has a strong recommendation with moderate-quality evidence, but its availability is limited 1
Cintapride is well-tolerated, but its efficacy is not specifically graded in the guidelines 4

The British Society of Gastroenterology suggests verifying the availability of prokinetics in the region, as many are unavailable outside Asia and the USA 1, 2, 3
If all three prokinetics are available, acotiamide 100 mg TID can be chosen for its robust clinical trial data and long-term safety evidence, cintapride can be chosen for patients with overlapping GERD symptoms, and itopride can be chosen if acotiamide is unavailable or unaffordable 1, 2, 3, 4

Prokinetics should be used only after H. pylori testing/eradication and trial of PPI therapy, according to the British Society of Gastroenterology guidelines 1, 2, 3
If prokinetics fail after 4-8 weeks, tricyclic antidepressants such as amitriptyline can be considered, as recommended by the British Society of Gastroenterology 1, 2, 6

The British Society of Gastroenterology advises against using prokinetics as first-line therapy, as PPIs have strong recommendations with high-quality evidence and should be tried first 1, 2, 3
Cintapride should not be combined with other QT-prolonging agents, and patients should be counseled that prokinetics work best for meal-related symptoms rather than epigastric pain, according to the British Society of Gastroenterology guidelines 4, 5