Efficacy and safety of prokinetics in gastrointestinal disorders. Review

Prokinetics are a heterogeneous class of drugs that enhance and coordinate gastrointestinal (GI) smooth muscle contraction to enhance gastric emptying and improve a wide range of motility disorders and related symptoms, even though high‑quality evidence is limited. These disorders range from very common but non‑fatal disorders such as functional dyspepsia (FD), gastroparesis or chronic idiopathic constipation (CIS) to severe motility disorders including chronic intestinal pseudo‑obstruction. Different classes of prokinetic agents with different mechanisms are available worldwide. Because of the great clinical need, many new drugs are currently under investigation or have recently been brought to market. Based on the latest recommendations of the European Association of Neurogastroenterology and Motility and the American Society of Neurogastroenterology and Motility, a review of the efficacy and safety of prokinetic agents in gastrointestinal disorders is presented. Such classes of kinetic agents as cholinesterase inhibitors (pyridostigmine, neostigmine, acotiamide), motilin agonists (erythromycin, mitemcinal), ghrelin agonists (relamorelin), muscarinic receptor agonists (bethanechol), 5‑HT4 receptor agonists (prucalopride, tegaserod, mosapride), dopamine D2 receptor antagonists (metoclopramide, domperidone, itopride, levosulpiride) were considered. The presented results demonstrated the potential benefits of prokinetics in improving gastrointestinal motility and symptom control through appropriate dose adjustments. However, further studies are needed to examine specific patient populations, optimal dosing regimens, and long‑term safety profiles of these drugs.