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.
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.
Futagami
Seiji
S
Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan. seiji.futagami@gmail.com
Iwakiri
Katsuhiko
K
Shindo
Tomotaka
T
Kawagoe
Tetsuro
T
Horie
Akane
A
Shimpuku
Mayumi
M
Tanaka
Yuriko
Y
Kawami
Noriyuki
N
Gudis
Katya
K
Sakamoto
Choitsu
C
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
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