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Comparison of PPIs and H_2-receptor antagonists plus prokinetics for dysmotility-like dyspepsia

World Journal of Gastroenterology 2012年第13期18卷 1517-1524页

作者： Masahiro Sakaguchi Miyuki Takao Yasuo Ohyama Hiroshi Oka Hiroshi Yamashita Takumi Fukuchi Kiyoshi Ashida Masahiro Murotani Masuyo Murotani Kazuo Majima Hiroshi Morikawa Takashi Hashimoto Keisuke Kiyota Hirohiko Esaki Kanji Amemoto Gouhei Isowa Fumiyuki Takao Department of Gastroenterology Moriguchi Keijinkai HospitalMoriguchiOsaka 570-0021Japan Department of Gastroenterology Osaka Saiseikai Nakatsu HospitalOsaka 530-0012Japan Murotani Clinic KadomaOsaka 571-0008Japan Majima Clinic NeyagawaOsaka 572-0084Japan Morikawa Clinic HirakataOsaka 573-0058Japan Hashimoto Clinic MoriguchiOsaka 570-0079Japan Kiyota Clinic MatsubaraOsaka 580-0004Japan Department of Gastroenterology Arisawa General HospitalHirakataOsaka 573-1195Japan Amemoto Clinic MoriguchiOsaka 570-0021Japan Isowa Clinic NeyagawaOsaka 572-0062Japan Mii Clinic NeyagawaOsaka 572-0019Japan

AIM： To compare efficacy of proton pump inhibitors （PPIs） with H2-receptor antagonists （H2RA$） plus pro- kinetics （Proks） for dysmotility-like symptoms in func- tional dyspepsia （FD）. METHODS： Subjects were randomized to receive openlabel treatment with either rabeprazole 10 mg od （n = 57） or famotidine 10 mg bid plus mosapride 5 mg tid （n = 57） for 4 wk. The primary efficacy endpoint was change （%） from baseline in total dysmotility-like dyspepsia symptom score. The secondary efficacy endpoint was patient satisfaction with treatment. RESULTS： The improvement in dysmotility-like dyspep- sia symptom score on day 28 was significantly greater in the rabeprazole group （22.5% ± 29.2% of baseline） than the famotidine ＋ mosapride group （53.2%±58.6% of baseline, P 〈 0.0001）. The superior benefit of rabeprazole treatment after 28 d was consistent regardless of Helicobacter pylori status. Significantly more subjects in the rabeprazole group were satisfied or very satisfied with treatment on day 28 than in the famotidine ＋ mosapride group （87.7% vs 59.6%, P = 0.0012）. Rabeprazole therapy was the only significant predictor of treatment response （P 〈 0.0001）, defined as a total symptom score improvement ≥ 50%. CONCLUSION： PPI monotherapy improves dysmotil- ity-like symptoms significantly better than H2RAs plus Proks, and should be the treatment of first choice for Japanese FD.

关键词： Dysmotility Functional dyspepsia H2-recep-tor antagonist prokinetics Proton pump inhibitor

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Addition of prokinetics to PPI therapy in gastroesophageal reflux disease:A meta-analysis

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World Journal of Gastroenterology 2014年第9期20卷 2412-2419页

作者： Li-Hua Ren Wei-Xu Chen Li-Juan Qian Shuo Li Min Gu Rui-Hua Shi Department of Gastroenterology the First Affiliated Hospital of Nanjing Medical University Department of Gastroenterology the First Affiliated Hospital of Soochow University

AIM: To investigate the efficacy of adding prokinetics to proton pump inhibitors (PPIs) for the treatment of gastroesophageal reflux disease (GERD).

关键词： Gastroesophageal reflux diseases Proton pump inhibitors prokinetics GABA-B receptor agonists Treatment Meta-analysis

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Efficacy of mosapride citrate with polyethylene glycol solution for colonoscopy preparation

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World Journal of Gastroenterology 2012年第20期18卷 2517-2525页

作者： Masahiro Tajika Yasumasa Niwa Vikram Bhatia Hiroki Kawai Shinya Kondo Akira Sawaki Nobumasa Mizuno Kazuo Hara Susumu Hijioka Kazuya Matsumoto Yuji Kobayashi Akira Saeki Asana Akabane Koji Komori Kenji Yamao Department of Endoscopy Aichi Cancer Center Hospital Nagoya 464-8681Japan Department of Medical Hepatology Institute of Liver and Biliary SciencesNew Delhi 110070India Department of Gastroenterology Aichi Cancer Center HospitalNagoya 464-8681Japan Department of Gastroenterological Surgery Aichi Cancer Center HospitalNagoya 464-8681Japan

AIM:To evaluate the efficacy and safety of adjunctive mosapride citrate for bowel preparation before colonoscopy. METHODS:We conducted a randomized,double-blind, placebo-controlled study with mosapride in addition to polyethylene glycol(PEG)-electrolyte *** 250 patients undergoing colonoscopy,124 were randomized to receive 2 L PEG plus 15 mg of mosapride citrate (mosapride group),and 126 received 2 L PEG plus placebo(placebo group).Patients completed a questionnaire reporting the acceptability and tolerability of the bowel preparation *** efficacy of bowel preparation was assessed by colonoscopists using a 5-point scale based on Aronchick's *** primary end point was optimal bowel preparation rates(scores of excellent/good/fair vs poor/inadequate). RESULTS:A total of 249 patients were included in the *** the mosapride group,optimal bowel preparation rates were significantly higher in the left colon compared with the placebo group(78.2%vs 65.6%,P<0.05),but not in the right colon(76.5%vs 66.4%,P=0.08).After excluding patients with severe constipation,there was a significant difference in bowel preparation in both the left and right colon(82.4%vs 66.7%,80.8%vs 67.5%,P<0.05,P<0.01).The incidence of adverse events was similar in both groups. Among the subgroup who had previous colonoscopy experience,a significantly higher number of patients in the mosapride group felt that the current preparation was easier compared with patients in the placebo group(34/72 patients vs 24/74 patients,P<0.05). CONCLUSION:Mosapride citrate may be an effective and safe adjunct to PEG-electrolyte solution that leads to improved quality of bowel preparation,especially in patients without severe constipation.

关键词： Mosapride citrate Bowel preparation Polyethylene glycol-electrolyte solution Colonoscopy prokinetics

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Chronic intestinal pseudo-obstruction

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World Journal of Gastroenterology 2008年第19期14卷 2953-2961页

作者： Alexandra Antonucci Lucia Fronzoni Laura Cogliandro Rosanna F Cogliandro Carla Caputo Roberto De Giorgio Francesca Pallotti Giovanni Barbara Roberto Corinaldesi Vincenzo Stanghellini Department of Internal Medicine and Gastroenterology University of Bologna

Chronic intestinal pseudo-obstruction (CIPO) is a se- vere digestive syndrome characterized by derangement of gut propulsive motility which resembles mechanical obstruction, in the absence of any obstructive process. Although uncommon in clinical practice, this syndrome represents one of the main causes of intestinal failure and is characterized by high morbidity and mortality. It may be idiopathic or secondary to a variety of diseases. Most cases are sporadic, even though familial forms with either dominant or recessive autosomal inheritance have been described. Based on histological features in- testinal pseudo-obstruction can be classified into three main categories:neuropathies, mesenchymopathies, and myopathies, according on the predominant involvement of enteric neurones, interstitial cells of Cajal or smooth muscle cells, respectively. Treatment of intestinal pseu- do-obstruction involves nutritional, pharmacological and surgical therapies, but it is often unsatisfactory and the long-term outcome is generally poor in the majority of cases.

关键词： Chronic intestinal pseudo-obstruction Smallbowel manometry Immunohistochemistry prokinetics Intestinal transplantation

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Can mosapride citrate reduce the volume of lavage solution for colonoscopy preparation?

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World Journal of Gastroenterology 2013年第5期19卷 727-735页

作者： Masahiro Tajika Yasumasa Niwa Vikram Bhatia Shinya Kondo Tsutomu Tanaka Nobumasa Mizuno Kazuo Hara Susumu Hijioka Hiroshi Imaoka Koji Komori Kenji Yamao Department of Endoscopy Aichi Cancer Center HospitalNagoya 464-8681Japan Department of Medical Hepatology Institute of Liver and Biliary SciencesNew Delhi 110070India Department of Gastroenterology Aichi Cancer Center HospitalNagoya 464-8681Japan Department of Gastroenterological surgery Aichi Cancer Center HospitalNagoya 464-8681Japan

AIM:To evaluate the possibility of reducing the volume of polyethylene glycol(PEG)-electrolyte solution using adjunctive mosapride citrate for colonoscopy preparation. METHODS:This was a single-center,prospective, randomized,investigator-blinded,non-inferiority study involving 252 patients of both sexes,aged from 20 to 80 years,scheduled for screening or diagnostic colonoscopy in our department.A total of 126 patients was randomized to receive 1.5 L PEG-electrolyte solution plus 15 mg of mosapride(1.5 L group),and 126 received 2 L PEG-electrolyte solution plus 15 mg of mosapride(2 L group).Patients completed a questionnaire on the acceptability and tolerability of the bowel preparation *** efficacy of bowel preparation was assessed using a 5-point scale based on the Aronchick *** primary end point was adequate bowel preparation rates(score of excellent/good/fair) vs(poor/inadequate).Acceptability and tolerability,as well as disease detection,were secondary end points. RESULTS:A total of 244 patients was included in the *** were no significant differences between the 2 L and 1.5 L groups in age,sex,body mass index, number of previous colonoscopies,and the preparation method used *** adequate bowel preparation rates were 88.5%in the 2 L group and 82.8%in the 1.5 L group[95%lower confidence limit(LCL)for the difference=-14.5%,non-inferiority P=0.019]in the right *** the left colon,the adequate bowel preparation rates were 89.3%in the 2 L group and 81.1%in the 1.5 L group(95%LCL=-17.0%,non-inferiority P=0.066).Compliance,defined as complete (100%)intake of the PEG solution,was significantly higher in the 1.5 L group than in the 2 L group(96.8% vs 85.7%,P=0.002).The proportion of abdominal distension(none/mild/moderate/severe)was significantly lower in the 1.5 L group than in the 2 L group (36/65/22/3 vs 58/48/18/2,P=0.040).Within the subgroup who had undergone colonoscopy previously, a significantly higher number of patients in t

关键词： Mosapride citrate Bowel preparation Polyethylene glycol-electrolyte solution prokinetics Colonoscopy

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Gastric electrical stimulation: An emerging therapy for children with intractable gastroparesis

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World Journal of Gastroenterology 2019年第48期25卷 6880-6889页

作者： Aniruddh Setya Priyanka Nair Sam Xianjun Cheng Department of Pediatric Gastroenterology Hepatology and Nutrition University of Florida

Management of gastroparesis remains challenging,particularly in pediatric *** care and pharmacological therapies for symptoms remain the mainstay *** they are effective for mild and some moderately severe cases,often time they do not work for severe *** are a few prokinetics available,yet the use of these drugs is limited by a lack of persistent efficacy and/or safety ***,the only modality for adult patients with severe intractable gastroparesis is surgery,e.g.,pyloroplasty and partial gastrectomy,however,this option is generally considered too radical for a growing *** therapeutic approaches,particularly those which are less invasive,are *** article explores gastric electrical stimulation(GES),a new therapy for *** others,it neither needs medications nor gastrectomy;rather,it treats through the use of microelectrodes to deliver high-frequency low energy electric stimulation to the pacemaker area of the ***,it is tolerated and safe in *** in adult patients,GES appears to work in releasing symptoms,improving nutrition,and enhancing the quality of life;it also helps wean off medications and eliminate many needs for *** the transient nature of gastroparesis in children in many occasions,GES is considered a“bridging”therapy after failed medical interventions and before surgery.

关键词： Gastroparesis Gastric electrical stimulation Nausea Vomiting prokinetics

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Gastroparesis:New insights into an old disease

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World Journal of Gastroenterology 2020年第19期26卷 2333-2348页

作者： Paolo Usai-Satta Massimo Bellini Olivia Morelli Francesca Geri Mariantonia Lai Gabrio Bassotti Department of Internal Medicine Division of GastroenterologyBrotzu HospitalCagliari 09124Italy Gastrointestinal Unit Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisa 56122Italy Gastroenterology and Hepatology Section Department of MedicineUniversity of Perugia Medical SchoolPerugia 06123Italy Gastroenterology Unit University of CagliariMonserrato 09042Italy

Gastroparesis(Gp)is a chronic disease characterized by a delayed gastric emptying in the absence of mechanical *** this condition has been reported in the literature since the mid-1900s,only recently has there been renewed clinical and scientific interest in this disease,which has a potentially great impact on the quality of *** aim of this review is to explore the pathophysiological,diagnostic and therapeutical aspects of Gp according to the most recent evidence.A comprehensive online search for Gp was carried out using MEDLINE and *** is the result of neuromuscular abnormalities of the gastric motor *** is evidence that patients with idiopathic and diabetic Gp may display a reduction in nitrergic inhibitory neurons and in interstitial cells of Cajal and/or *** regards diagnostic approach,99-Technetium scintigraphy is currently considered to be the gold standard for *** limits are a lack of standardization and a mild risk of radiation *** C13 breath testing is a valid and safe alternative method.13C acid octanoic and the 13C Spirulina platensis recently approved by the Food and Drug Administration are the most commonly used diagnostic *** wireless motility capsule is a promising technique,but its use is limited by costs and scarce availability in many ***,therapeutic strategies are related to the clinical severity of *** mild and moderate Gp,dietary modification and prokinetic agents are generally *** is the only drug approved by the Food and Drug Administration for ***,other older and new prokinetics and antiemetics can be *** a second-line therapy,tricyclic antidepressants and cannabinoids have been *** severe cases the normal nutritional approach can be compromised and artificial nutrition may be *** drug-unresponsive Gp patients some alternative strategies(endoscopic,electric stimulation or surgery)are available.

关键词： Gastroparesis Delayed gastric emptying Gastric Scintigraphy 13C breath testing Wireless motility capsule prokinetics Antiemetic drugs Gastric-per-oral endoscopic myotomy Gastric electrical stimulation

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Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation(Part Ⅱ:Treatment)

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World Journal of Gastroenterology 2012年第14期18卷 4994-5013页

作者： Antonio Bove Massimo Bellini Edda Battaglia Renato Bocchini Dario Gambaccini Vincenzo Bove Filippo Pucciani Donato Francesco Altomare Giuseppe Dodi Guido Sciaudone Ezio Falletto Vittorio Piloni Gastroenterology and Endoscopy Unit Department of GastroenterologyAORN "A.Cardarelli"80131 NaplesItaly Gastrointestinal Unit Department of GastroenterologyUniversity of Pisa56100 PisaItaly Gastroenterology and Endoscopy Unit Cardinal Massaja Hospital14100 AstiItaly Gastroenterology Unit M.Bufalini Hospital47023 CesenaItaly Department of Medical and Surgical Critical Care University of Florence50141 FlorenceItaly Department of Emergency and Organ Transplantation University of Bari70124 BariItaly Department of Oncological and Surgical Sciences University of Padua35126 PaduaItaly Division of General and Geriatric Surgery Second University of Naples80131 NaplesItaly Sixth Division of University Surgery Department of General SurgerySan Giovanni Battista Hospital10126 TurinItaly Diagnostic Imaging Centre "N.Aliotta" Villa Silvia-SenigalliaI-60100 AnconaItaly

The second part of the Consensus Statement of the Italian Association of Hospital Gastroenterologists and Italian Society of Colo-Rectal Surgery reports on the treatment of chronic constipation and obstructed defecation. There is no evidence that increasing fluid intake and physical activity can relieve the symptoms of chronic constipation. Patients with normal-transit constipation should increase their fibre intake through their diet or with commercial fibre. Osmotic laxatives may be effective in patients who do not respond to fibre supplements. Stimulant laxatives should be re- served for patients who do not respond to osmotic laxatives. Controlled trials have shown that serotonin- ergic enterokinetic agents, such as prucalopride, and prosecretory agents, such as lubiprostone, are effec- tive in the treatment of patients with chronic constipa- tion. Surgery is sometimes necessary. Total colectomy with ileorectostomy may be considered in patients with slow-transit constipation and inertia coil who are resistant to medical therapy and who do not have defecatory disorders, generalised motility disorders or psychological disorders. Randomised controlled trials have established the efficacy of rehabilitative treat- ment in dys-synergic defecation. Many surgical proce- dures may be used to treat obstructed defecation in patients with acquired anatomical defects, but none is considered to be the gold standard. Surgery should be reserved for selected patients with an impaired quality of life. Obstructed defecation is often associated with pelvic organ prolapse. Surgery with the placement of prostheses is replacing fascial surgery in the treatment of pelvic organ prolapse, but the efficacy and safety of such procedures have not yet been established.

关键词： Laxatives prokinetics Biofeedback Pelvicfloor rehabilitation Outlet obstruction Stapled trans-anal rectal resection Delorme operation Colectomy Pelvic organ prolapse Mesh

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Personalized medicine in functional gastrointestinal disorders:Understanding pathogenesis to increase diagnostic and treatment efficacy

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World Journal of Gastroenterology 2019年第10期25卷 1185-1196页

作者： Xiao Jing Wang Michael Camilleri Division of Gastroenterology and Hepatology Clinical Enteric Neuroscience Translational and Epidemiological ResearchMayo Clinic

There is overwhelming evidence that functional gastrointestinal disorders(FGIDs) are associated with specific mechanisms that constitute important targets for personalized treatment. There are specific mechanisms in patients presenting with functional upper gastrointestinal symptoms(UGI Sx). Among patients with UGI Sx, approximately equal proportions(25%) of patients have delayed gastric emptying(GE), reduced gastric accommodation(GA), both impaired GE and GA,or neither, presumably due to increased gastric or duodenal *** targeted to the underlying pathophysiology utilize prokinetics,gastric relaxants, or central neuromodulators. Similarly, specific mechanisms in patients presenting with functional lower gastrointestinal symptoms, especially with diarrhea or constipation, are recognized, including at least 30% of patients with functional constipation pelvic floor dyssynergia and 5% has colonic inertia(with neural or interstitial cells of Cajal loss in myenteric plexus); 25% of patients with diarrhea-predominant irritable bowel syndrome(IBSD) has evidence of bile acid diarrhea; and, depending on ethnicity, a varying proportion of patients has disaccharidase deficiency, and less often sucrose-isomaltase deficiency. Among patients with predominant pain or bloating, the role of fermentable oligosaccharides, disaccharides, monosaccharides and polyols should be considered. Personalization is applied through pharmacogenomics related to drug pharmacokinetics, specifically the role of CYP2 D6, 2 C19 and 3 A4 in the use of drugs for treatment of patients with FGIDs. Single mutations or multiple genetic variants are relatively rare, with limited impact to date on the understanding or treatment of FGIDs. The role of mucosal gene expression in FGIDs, particularly in IBS-D, is the subject of ongoing research. In summary, the time for personalization of FGIDs, based on deep phenotyping, is here;pharmacogenomics is relevant in the use of central neuromodulators.

关键词： Gastrointestinal symptoms Gastric emptying Gastric accommodation Diarrhea Constipation Irritable bowel syndrome Bile acid diarrhea Phenotypes Pharmacogenomics prokinetics Neuromodulators

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Constipation-predominant irritable bowel syndrome: A review of current and emerging drug therapies

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World Journal of Gastroenterology 2014年第27期20卷 8898-8909页

作者： Khaled A Jadallah Susan M Kullab David S Sanders Department of InternalMedicine King Abdullah University Hospital Faculty of Medicine Jordan University of Science and Technology Department of Gastroenterology and Liver Unit Royal Hallamshire Hospital Sheffield South Yorkshire S102JF United Kingdom

Irritable bowel syndrome(IBS) is a highly prevalent medical condition that adversely affects patient quality of life and constitutes a significant economic burden on healthcare resources. A large proportion of patients suffer from the constipation subtype of IBS(IBS-C), most commonly afflicting older individuals and those with a lower socioeconomic status. Conventional pharmacologic and nonpharmacologic treatment options have limited efficacies and/or significant adverse events, which lead to increased long-term health care expenditures. Failure to effectively treat IBS-C patients over the past decades has largely been due to a poor understanding of disease pathophysiology, lack of a global view of the patient, and an inappropriate selection of patients and treatment endpoints in clinical trials. In recent years, however, more effective and safer drugs have been developed for the treatment of IBS-C. The advancement in the area of pharmacologic treatment is based on new knowledge of the pathophysiologic basis of IBS-C and the development of drugs with increased selectivity within pharmacologic classes with recognized efficacies. This narrative review covers the spectrum of available drugs and their mechanisms of action, as well as the efficacy and safety profiles of each as determined in relevant clinical trials that have investigated treatment options for IBS-C and chronic constipation. A brief summary of laxative-based treatment options is presented, followed by up-to-date assessments for three classes of drugs: prokinetics, prosecretory agents, and bile acid modulators.

关键词： Constipation Irritable bowel syndrome Drug therapy Serotonergic agents prokinetics 5-hydroxytryptamine type 4 agonists Secretagogues Prosecretory agents Bile acid modulators

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