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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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Efficacy of endoluminal gastroplication in Japanese patients with proton pump inhibitor-resistant,non-erosive esophagitis

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World Journal of Gastroenterology 2012年第41期18卷 5940-5947页

作者： Kentaro Tokudome Yasushi Funaki Makoto Sasaki Shinya Izawa Yasuhiro Tamura Akihito Iida Naotaka Ogasawara Toshihiro Konagaya Yoshifumi Tokura Kunio Kasugai Division of Gastroenterology Department of Internal MedicineAichi Medical University School of MedicineAichi 480-1195Japan Department of clinical Laboratory Aichi Medical University School of MedicineAichi 480-1195Japan Marine clinic NagoyaAichi 460-0002Japan Tokura Yoshifumi Stomach and Intestines Internal Medicine clinic Kyoto 615-8256Japan

AIM： To evaluate the efficacy, safety, and long-term outcomes of endoluminal gastroplication （ELGP） in pa- tients with proton pump inhibitor （PPI）-resistant, non- erosive reflux disease （NERD）. METHODS： The subjects were NERD patients, diag- nosed by upper endoscopy before PPI use, who had symptoms such as heartburn or reflux sensations two or more times a week even after 8 wk of full-dose PPI treatment. Prior to ELGP, while continuing full-dose PPImedication, patients＇ symptoms and quality of life （QOL） were assessed using the questionnaire for the diagno- sis of reflux disease, the frequency scale for symptoms of gastro-esophageal reflux disease （FSSG）, gastroin- testinal symptoms rating scale, a 36-item short-form. In addition, 24-h esophageal pH monitoring or 24-h in- traesophageal pH/impedance （mii-pH） monitoring was performed. The Bard EndoCinchTM was used for ELGP, and 2 or 3 plications were made. After ELGP, all acid reducers were temporarily discontinued, and medica- tion was resumed depending on the development and severity of symptoms. Three mo after ELGP, symptoms, QOL, pH or mii-pH monitoring, number of plications, and PPI medication were evaluated. Further, symptoms, number of plications, and PPI medication were evalu- ated 12 mo after ELGP to investigate long-term effects. RESULTS： The mean FSSG score decreased signifi- cantly from before ELGP to 3 and 12 mo after ELGP （19.1 ：k 10.5 to 10.3 ＋ 7.4 and 9.3 ＋ 9.9, P 〈 0.05, respectively）. The total number of plications decreased gradually at 3 and 12 mo after ELGP （2.4 ＋ 0.8 to 1.2 ：l： 0.8 and 0.8 ：l： 1.0, P 〈 0.05, respectively）. The FSSG scores in cases with no remaining plications and in cases with one or more remaining plications were 4.4 and 2.7, respectively, after 3 too, and 2.0 and 2.8, respectively, after 12 mo, showing no correlation to plication loss. On pH monitoring, there was no differ- ence in the percent time pH 〈 4 from before ELGP to 3 mo after. Impedance monitoring revealed no changes

关键词： Endoluminal gastroplication EsophagealpH Gastro-esophageal reflux disease Non-erosive re-flux disease Proton pump inhibitor-resistant

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