Effect of mosapride combined with esomeprazole improves esophageal peristaltic function in patients with gastroesophageal reflux disease: a study using high resolution manometry.
BACKGROUND
Whether addition of prokinetics to proton pump inhibitors improves esophageal peristalsis and symptoms in patients with gastroesophageal reflux disease (GERD) remains unknown.


OBJECTIVE
We evaluated the effect of mosapride, a 5-HT4 agonist, and PPI cotherapy in patients with GERD on esophageal motility using high-resolution manometry (HRM).


METHODS
This study was designed as a double-blind, randomized, placebo-controlled trial. Patients with GERD were allocated to a group either taking 40 mg esomeprazole plus 30 mg mosapride or taking esomeprazole plus placebo. Symptom assessment and the HRM study were conducted before drug treatment and after 4 weeks.


RESULTS
Of 50 patients enrolled, 24 in the mosapride group (49 years old, 15 males) and 19 in the placebo group (43 years old, nine males) completed the study. Approximately 79 % of the patients had normal peristaltic function. Treatment response was not different between the two groups (79 vs. 68 %). Mosapride cotherapy tended to yield better response in patients with dyspepsia than those without dyspepsia (92 vs. 67 %). Lower esophageal sphincter pressure didn't change in both groups. Intrabolus pressure decreased in the mosapride group (3.4 ± 3.5 mmHg to 1.4 ± 4.1 mmHg, P < 0.05). Distal esophageal amplitude increased in the mosapride group and not in the placebo group (81 ± 34 to 89 ± 29 mmHg vs. 82 ± 32 to 83 ± 31 mmHg).


CONCLUSIONS
Adding mosapride on esomeprazole improved esophageal contractability and lowered intrabolus pressure in patients with GERD. Mosapride and esomeprazole cotherapy tended to yield better response in patients with concomitant dyspepsia.
Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 505 Banpodong, Seochogu, Seoul, Korea.
Yu Kyung
YK
Cho
Myung-Gyu
MG
Choi
Eun Young
EY
Park
Chul Hyun
CH
Lim
Jin Su
JS
Kim
Jae Myung
JM
Park
In Seok
IS
Lee
Sang Woo
SW
Kim
Kyu Yong
KY
Choi
D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001549:Benzamides / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D064098:Esomeprazole / Q000627:therapeutic use; D004947:Esophagus / Q000187:drug effects*; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009025:Morpholines / Q000627:therapeutic use*; D010528:Peristalsis / Q000187:drug effects*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use*
D000897:Anti-Ulcer Agents; D001549:Benzamides; D009025:Morpholines; D054328:Proton Pump Inhibitors; D017366:Serotonin Receptor Agonists; C062720:mosapride; D064098:Esomeprazole