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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

  • Original Article—Alimentary Tract
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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

Tmax 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 Tmax value in Tmax > 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.

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Acknowledgments

This work was supported in part by grants from the Ministry of Education, Culture, and Science and from the Ministry of Health, Japan.

Conflict of interest statement

There is no conflict of interest statement in this study.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan

    Seiji Futagami, Katsuhiko Iwakiri, Tomotaka Shindo, Tetsuro Kawagoe, Akane Horie, Mayumi Shimpuku, Yuriko Tanaka, Noriyuki Kawami, Katya Gudis & Choitsu Sakamoto

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  1. Seiji Futagami
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  2. Katsuhiko Iwakiri
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  3. Tomotaka Shindo
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  4. Tetsuro Kawagoe
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Correspondence to Seiji Futagami.

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Futagami, S., Iwakiri, K., Shindo, T. et al. 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. J Gastroenterol 45, 413–421 (2010). https://doi.org/10.1007/s00535-009-0173-0

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