Prokinetische

Prokinetische refers to drugs or actions that enhance gastrointestinal motility, helping the movement of contents through the stomach and intestines. Prokinetic agents are used to treat disorders characterized by delayed gastric emptying or slowed intestinal transit, such as gastroparesis, functional dyspepsia, gastroesophageal reflux with motility impairment, and postoperative ileus. They may also be employed in certain cases of chronic constipation or to facilitate procedures requiring coordinated GI motility.

The pharmacologic mechanisms of prokinetische agents are diverse. Some drugs are dopamine D2 receptor antagonists, which increase acetylcholine release in the enteric nervous system and thereby promote smooth muscle contractions (for example, certain metoclopramide and domperidone derivatives). Others are serotonin 5-HT4 receptor agonists that enhance proximal GI motility by facilitating acetylcholine release. A third group includes motilin receptor agonists, which mimic the action of the endogenous hormone motilin to stimulate gastric and small-bowel contractions. Individual agents differ in receptor targets, selectivity, and central versus peripheral effects.

Commonly cited examples include metoclopramide, domperidone, and prucalopride, with historical agents such as cisapride having limited use due to safety concerns. Erythromycin acts as a motilin receptor agonist and is used in specific short-term settings. The choice of agent depends on the underlying disorder, patient tolerance, and regulatory status, as well as potential adverse effects such as extrapyramidal symptoms, QT interval prolongation, and drug interactions.

In clinical practice, prokinetische therapy aims to improve symptoms and nutritional status while balancing efficacy with safety. Ongoing research seeks more selective agents with fewer CNS and cardiovascular risks, and improved effectiveness across diverse motility disorders.