title: Improvement of meal-related symptoms and epigastric pain in patients with functional dyspepsia treated with acotiamide was associated with acylated ghrelin levels in Japan.
abstract: The aim of this study is to clarify whether acotiamide and rabeprazole combination therapy can improve clinical symptoms, gastric emptying, and satisfaction with treatment in functional dyspepsia (FD) patients more effectively than acotiamide or rabeprazole monotherapy alone. We also aimed to determine whether acotiamide affects these changes via its effect on gastric emptying and appetite-related hormones such as ghrelin.
  
  
  
  We used Rome III criteria to evaluate upper abdominal symptoms and anxiety by the State-Trait Anxiety Inventory (STAI). Gastric motility was evaluated by the (13) C-acetate breath test. Eighty-one FD patients were treated with acotiamide (300 mg/day) (n = 35), acotiamide (300 mg/day) and rabeprazole (10 mg/day) (n = 28), or rabeprazole (10 mg/day) (n = 18) for a period of 4 weeks and followed after 4 weeks of no treatment. Adenocorticotropic hormone (ACTH), cortisol, leptin and ghrelin levels were measured in all FD patients.
  
  
  
  Acotiamide and rabeprazole combination therapy significantly improved postprandial distress syndrome (PDS)-like symptoms (p = 0.018, p = 0.04 and p = 0.041, respectively) and epigastric pain (p = 0.024) as wells as STAI-state scores (p = 0.04) compared to rabeprazole monotherapy. Both acotiamide monotherapy, and acotiamide taken in combination with rabeprazole, significantly (p = 0.001 and p = 0.02, respectively) improved satisfaction with treatment, compared to rabeprazole monotherapy. Acotiamide and rabeprazole combination therapy had no significant effect on ACTH and cortisol levels in FD patients. Of interest, acotiamide monotherapy, and acotiamide and rabeprazole combination therapy, significantly (p < 0.0001 and p = 0.018, respectively) increased acylated ghrelin/total ghrelin ratios and significantly (p = 0.04) improved impaired gastric emptying compared to rabeprazole monotherapy.
  
  
  
  Further studies are warranted to clarify how acotiamide treatment improves clinical symptoms in FD patients.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Yamawaki
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Futagami
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kawagoe
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Maruki
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Hashimoto
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Nagoya
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Sato
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kodaka
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Gudis
authors.affiliation: The First Department of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Akamizu
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: C
authors.initials: C
authors.lastname: Sakamoto
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Iwakiri
mesh_terms: D015746:Abdominal Pain / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D000215:Acylation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001549:Benzamides / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D004359:Drug Therapy, Combination; D004415:Dyspepsia / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage; D054439:Ghrelin / Q000097:blood*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D062407:Meals / Q000187:drug effects / Q000502:physiology*; D008875:Middle Aged; D019518:Postprandial Period / Q000187:drug effects / Q000502:physiology*; D011446:Prospective Studies; D064750:Rabeprazole / Q000008:administration & dosage; D013844:Thiazoles / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001549:Benzamides; D015415:Biomarkers; D005765:Gastrointestinal Agents; D054439:Ghrelin; D013844:Thiazoles; D064750:Rabeprazole; C410959:Z 338
keywords: acotiamide; functional dyspepsia; gastric motility; ghrelin; meal-related symptoms; rabeprazole