title: The prokinetic effect of mosapride citrate combined with omeprazole therapy improves clinical symptoms and gastric emptying in PPI-resistant NERD patients with delayed gastric emptying.
abstract: BACKGROUND
  Previous studies have shown that non-erosive reflux disease (NERD) patients are less sensitive to proton pump inhibitor (PPI) treatment than patients with erosive reflux disease. The aim of this study was to investigate whether treatment with prokinetics in addition to omeprazole therapy would improve clinical symptoms, gastric emptying and esophageal peristalsis in PPI-resistant NERD patients with or without delayed gastric emptying.
  
  
  METHODS
  Subjects were 64 consecutive patients presenting with typical symptoms of PPl-resistant NERD (n = 44) and 20 healthy volunteers. PPI-resistant NERD patients underwent mosapride citrate (15 mg/day) and omeprazole (20 mg/day) co-therapy for 12 weeks. We evaluated the clinical symptoms as well as gastric emptying and esophageal manometry before and after combined therapy. We measured both acylated- and des-acylated plasma ghrelin levels by the ELISA method. The primary endopoint was to investigate whether co-administration of mosapride citrate and omeprazole would improve clinical symptoms and gastric emptying in PPI-resistant NERD patients with delayed gastric emptying.
  
  
  RESULTS
  T (max) value in PPI-resistant NERD patients was significantly higher than in healthy volunteers. Combination therapy with the prokinetic agent mosapride citrate and omeprazole significantly improved reflux symptoms and T (max) value in T (max) > 65 min NERD patients. Co-therapy also significantly reduced des-acylated-ghrelin levels in NERD patients with delayed gastric emptying.
  
  
  CONCLUSIONS
  Administration of mosapride citrate in addition to omeprazole improved gastro-esophageal reflux and gastric emptying in PPI-resistant NERD patients with delayed gastric emptying.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan. seiji.futagami@gmail.com
authors.forename: Seiji
authors.initials: S
authors.lastname: Futagami
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Iwakiri
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Shindo
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kawagoe
authors.forename: Akane
authors.initials: A
authors.lastname: Horie
authors.forename: Mayumi
authors.initials: M
authors.lastname: Shimpuku
authors.forename: Yuriko
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Kawami
authors.forename: Katya
authors.initials: K
authors.lastname: Gudis
authors.forename: Choitsu
authors.initials: C
authors.lastname: Sakamoto
mesh_terms: D000328:Adult; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001549:Benzamides / Q000008:administration & dosage / Q000627:therapeutic use*; D016022:Case-Control Studies; D004311:Double-Blind Method; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005746:Gastric Emptying; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000503:physiopathology; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D054439:Ghrelin / Q000097:blood; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D009025:Morpholines / Q000008:administration & dosage / Q000627:therapeutic use*; D009853:Omeprazole / Q000008:administration & dosage / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000897:Anti-Ulcer Agents; D001549:Benzamides; D005765:Gastrointestinal Agents; D054439:Ghrelin; D009025:Morpholines; D054328:Proton Pump Inhibitors; C422650:ghrelin, des-n-octanoyl; C062720:mosapride; D009853:Omeprazole