TY - JOUR
T1 - The treatment effects of acotiamide in esophagogastric outflow obstruction
T2 - a prospective longitudinal observational study
AU - Ihara, Eikichi
AU - Ogino, Haruei
AU - Muta, Kazumasa
AU - Hamada, Shohei
AU - Wada, Masafumi
AU - Hata, Yoshitaka
AU - Ikeda, Hiroko
AU - Bai, Xiaopeng
AU - Minoda, Yosuke
AU - Esaki, Mitsuru
AU - Tanaka, Yoshimasa
AU - Chinen, Takatoshi
AU - Ogawa, Yoshihiro
N1 - Funding Information:
Grant Support: This study was supported in part by the Japan Society for the Promotion of Science KAKENHI (20K08334) and the Project Promoting Clinical Trials for Development of New Drugs and Medical Devices (Japan Medical Association) from the Japan Agency for Medical Research and Development (AMED) (19lk0201088h0001 and 21lk0201144h0001).
Publisher Copyright:
© 2021, The Japan Esophageal Society.
PY - 2022/4
Y1 - 2022/4
N2 - Objectives: We have found that an altered lower esophageal sphincter (LES) accommodation response is an underlying cause of esophagogastric junction outflow obstruction (EGJOO). The objective of this study was to examine the treatment effect of acotiamide, a prokinetic agent which improves impaired gastric accommodation in functional dyspepsia, in patients with EGJOO. Methods: A prospective observational longitudinal study was conducted between October 2014 and March 2020. Acotiamide (100 mg, 3 times a day) was administered to 25 patients with EGJOO for 4 weeks. High-resolution manometry (HRM) was performed just before and after 4 weeks of treatment. Results: As the primary outcome, the extent of integrated relaxation pressure (IRP) after treatment (14.6, 12.1–22.0 mmHg) was significantly lower than that before treatment (19.4, 17.1–27.4 mmHg). The extent of LES accommodation index after treatment (32.7, 21.0–40.0 mmHg) was also significantly lower than that before treatment (39.3, 31.2–50.2 mmHg). Acotiamide normalized the IRP (< 15 mmHg) in 13 of 25 patients with EGJOO (52%), and the IRP was decreased in 20 of 25 patients with EGJOO (80%). As the secondary outcome, the total FSSG score in 25 patients with EGJOO before and after acotiamide treatment showed no significant difference. In a sub-analysis of 13 patients in whom EGJOO was normalized by acotiamide, however, dysphagia was reported to be significantly improved by acotiamide. Conclusions: Acotiamide has a treatment effect on patients with EGJOO via a reduction in the IRP level through the lowering of both the basal LES pressure and LES accommodation response. Dysphagia is a key symptom to be evaluated and treated in patients with EGJOO.
AB - Objectives: We have found that an altered lower esophageal sphincter (LES) accommodation response is an underlying cause of esophagogastric junction outflow obstruction (EGJOO). The objective of this study was to examine the treatment effect of acotiamide, a prokinetic agent which improves impaired gastric accommodation in functional dyspepsia, in patients with EGJOO. Methods: A prospective observational longitudinal study was conducted between October 2014 and March 2020. Acotiamide (100 mg, 3 times a day) was administered to 25 patients with EGJOO for 4 weeks. High-resolution manometry (HRM) was performed just before and after 4 weeks of treatment. Results: As the primary outcome, the extent of integrated relaxation pressure (IRP) after treatment (14.6, 12.1–22.0 mmHg) was significantly lower than that before treatment (19.4, 17.1–27.4 mmHg). The extent of LES accommodation index after treatment (32.7, 21.0–40.0 mmHg) was also significantly lower than that before treatment (39.3, 31.2–50.2 mmHg). Acotiamide normalized the IRP (< 15 mmHg) in 13 of 25 patients with EGJOO (52%), and the IRP was decreased in 20 of 25 patients with EGJOO (80%). As the secondary outcome, the total FSSG score in 25 patients with EGJOO before and after acotiamide treatment showed no significant difference. In a sub-analysis of 13 patients in whom EGJOO was normalized by acotiamide, however, dysphagia was reported to be significantly improved by acotiamide. Conclusions: Acotiamide has a treatment effect on patients with EGJOO via a reduction in the IRP level through the lowering of both the basal LES pressure and LES accommodation response. Dysphagia is a key symptom to be evaluated and treated in patients with EGJOO.
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U2 - 10.1007/s10388-021-00887-1
DO - 10.1007/s10388-021-00887-1
M3 - Article
C2 - 34626276
AN - SCOPUS:85116564480
VL - 19
SP - 332
EP - 342
JO - Esophagus
JF - Esophagus
SN - 1612-9059
IS - 2
ER -