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However, prokinetic agents can also be employed in the absence of such deficits but where an increase of baseline motility can be demonstrated to generate benefit, such as in GERD. In several disease states patient symptoms result from a reduction in motility in the GI tract. In a subset of these patients, this results in a significant symptom burden, most commonly manifest as nausea, vomiting, and early satiety, and in these patients the use of prokinetic agents can improve symptoms. Similarly, reduced motility in the distal GI tract, from either iatrogenic or idiopathic causes, can result in constipation, which can become chronic and present a significant problem to patients. Prokinetic agents also appear to have a significant impact in the treatment of postoperative ileus. During surgery a combination of opioid analgesia and anesthetic use, incision of the peritoneum, and handling of the intestines results in a temporary cessation of GI motility, most probably through a combination of pharmacologic, physiologic, and inflammatory events.
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