Esophageal Motility and Rikkunshito Treatment for Proton Pump Inhibitor-Refractory Nonerosive Reflux Disease: A Prospective, Uncontrolled, Open-Label Pilot Study Trial
Background: Only a few reports focused on esophageal motility in patients with proton pump inhibitor (PPI)-refractory nonerosive reflux disease (NERD) and there has been no established strategy for treatment. Objective: To clarify the characteristics of esophageal motility in patients with PPI-refra...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2017-01-01
|
| Series: | Current Therapeutic Research |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0011393X1730019X |
| _version_ | 1819094516020281344 |
|---|---|
| author | Takeo Odaka, MD, PhD Shigeru Yamato, MD, PhD Osamu Yokosuka, MD, PhD |
| author_facet | Takeo Odaka, MD, PhD Shigeru Yamato, MD, PhD Osamu Yokosuka, MD, PhD |
| author_sort | Takeo Odaka, MD, PhD |
| collection | DOAJ |
| description | Background: Only a few reports focused on esophageal motility in patients with proton pump inhibitor (PPI)-refractory nonerosive reflux disease (NERD) and there has been no established strategy for treatment.
Objective: To clarify the characteristics of esophageal motility in patients with PPI-refractory NERD, we evaluated esophageal function using combined multichannel intraluminal impedance and esophageal manometry (MII-EM). In addition, we evaluated the efficacy of rikkunshito (RKT), which is a gastrointestinal prokinetic agent.
Methods: Thirty patients with NERD were enrolled and underwent MII-EM. After 8 weeks of RKT (7.5 g/d) treatment, MII-EM was repeated on patients with PPI-refractory NERD. Symptoms were assessed by the Gastrointestinal Symptom Rating Scale.
Results: In patients with PPI-refractory NERD, measures of complete bolus transit, peristaltic contractions, and residual pressure of the lower esophageal sphincter during swallowing deviated from the standard values and esophageal clearance was found to be deteriorated. RKT significantly improved the peristaltic contractions (P < 0.05), the complete bolus transit (P < 0.01), and the residual pressure of lower esophageal sphincter (P < 0.05) in these patients. The overall score (P < 0.01) and the subscale scores of acid reflux syndrome (P < 0.05), abdominal pain (P < 0.05), and indigestion syndrome (P < 0.01) in the Gastrointestinal Symptom Rating Scale were significantly improved by the 8-week RKT treatment.
Conclusions: In the pilot study, patients with PPI-refractory NERD had disorders of esophageal and lower esophageal sphincter motility that were improved by RKT. Further studies examining esophageal motor activity of RKT in PPI-refractory NERD are required. University hospital Medical Information Network (UMIN) Clinical Trial Registry identifier: UMIN000003092. |
| first_indexed | 2024-12-21T23:28:39Z |
| format | Article |
| id | doaj.art-45dcabef084044a1ba158d52258197bf |
| institution | Directory Open Access Journal |
| issn | 0011-393X 1879-0313 |
| language | English |
| last_indexed | 2024-12-21T23:28:39Z |
| publishDate | 2017-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Current Therapeutic Research |
| spelling | doaj.art-45dcabef084044a1ba158d52258197bf2022-12-21T18:46:33ZengElsevierCurrent Therapeutic Research0011-393X1879-03132017-01-0184C374110.1016/j.curtheres.2017.03.007Esophageal Motility and Rikkunshito Treatment for Proton Pump Inhibitor-Refractory Nonerosive Reflux Disease: A Prospective, Uncontrolled, Open-Label Pilot Study TrialTakeo Odaka, MD, PhD0Shigeru Yamato, MD, PhD1Osamu Yokosuka, MD, PhD2Odaka Medical and Gastrointestinal Clinic, Chiba, JapanDivision of Gastroenterology, National Center of Neurology & Psychiatry, Tokyo, JapanFunabashi Central Hospital, Chiba, JapanBackground: Only a few reports focused on esophageal motility in patients with proton pump inhibitor (PPI)-refractory nonerosive reflux disease (NERD) and there has been no established strategy for treatment. Objective: To clarify the characteristics of esophageal motility in patients with PPI-refractory NERD, we evaluated esophageal function using combined multichannel intraluminal impedance and esophageal manometry (MII-EM). In addition, we evaluated the efficacy of rikkunshito (RKT), which is a gastrointestinal prokinetic agent. Methods: Thirty patients with NERD were enrolled and underwent MII-EM. After 8 weeks of RKT (7.5 g/d) treatment, MII-EM was repeated on patients with PPI-refractory NERD. Symptoms were assessed by the Gastrointestinal Symptom Rating Scale. Results: In patients with PPI-refractory NERD, measures of complete bolus transit, peristaltic contractions, and residual pressure of the lower esophageal sphincter during swallowing deviated from the standard values and esophageal clearance was found to be deteriorated. RKT significantly improved the peristaltic contractions (P < 0.05), the complete bolus transit (P < 0.01), and the residual pressure of lower esophageal sphincter (P < 0.05) in these patients. The overall score (P < 0.01) and the subscale scores of acid reflux syndrome (P < 0.05), abdominal pain (P < 0.05), and indigestion syndrome (P < 0.01) in the Gastrointestinal Symptom Rating Scale were significantly improved by the 8-week RKT treatment. Conclusions: In the pilot study, patients with PPI-refractory NERD had disorders of esophageal and lower esophageal sphincter motility that were improved by RKT. Further studies examining esophageal motor activity of RKT in PPI-refractory NERD are required. University hospital Medical Information Network (UMIN) Clinical Trial Registry identifier: UMIN000003092.http://www.sciencedirect.com/science/article/pii/S0011393X1730019Xproton pump inhibitornon-erosive reflux diseasehigh-resolution impedance manometryesophageal motilityrikkunshito |
| spellingShingle | Takeo Odaka, MD, PhD Shigeru Yamato, MD, PhD Osamu Yokosuka, MD, PhD Esophageal Motility and Rikkunshito Treatment for Proton Pump Inhibitor-Refractory Nonerosive Reflux Disease: A Prospective, Uncontrolled, Open-Label Pilot Study Trial Current Therapeutic Research proton pump inhibitor non-erosive reflux disease high-resolution impedance manometry esophageal motility rikkunshito |
| title | Esophageal Motility and Rikkunshito Treatment for Proton Pump Inhibitor-Refractory Nonerosive Reflux Disease: A Prospective, Uncontrolled, Open-Label Pilot Study Trial |
| title_full | Esophageal Motility and Rikkunshito Treatment for Proton Pump Inhibitor-Refractory Nonerosive Reflux Disease: A Prospective, Uncontrolled, Open-Label Pilot Study Trial |
| title_fullStr | Esophageal Motility and Rikkunshito Treatment for Proton Pump Inhibitor-Refractory Nonerosive Reflux Disease: A Prospective, Uncontrolled, Open-Label Pilot Study Trial |
| title_full_unstemmed | Esophageal Motility and Rikkunshito Treatment for Proton Pump Inhibitor-Refractory Nonerosive Reflux Disease: A Prospective, Uncontrolled, Open-Label Pilot Study Trial |
| title_short | Esophageal Motility and Rikkunshito Treatment for Proton Pump Inhibitor-Refractory Nonerosive Reflux Disease: A Prospective, Uncontrolled, Open-Label Pilot Study Trial |
| title_sort | esophageal motility and rikkunshito treatment for proton pump inhibitor refractory nonerosive reflux disease a prospective uncontrolled open label pilot study trial |
| topic | proton pump inhibitor non-erosive reflux disease high-resolution impedance manometry esophageal motility rikkunshito |
| url | http://www.sciencedirect.com/science/article/pii/S0011393X1730019X |
| work_keys_str_mv | AT takeoodakamdphd esophagealmotilityandrikkunshitotreatmentforprotonpumpinhibitorrefractorynonerosiverefluxdiseaseaprospectiveuncontrolledopenlabelpilotstudytrial AT shigeruyamatomdphd esophagealmotilityandrikkunshitotreatmentforprotonpumpinhibitorrefractorynonerosiverefluxdiseaseaprospectiveuncontrolledopenlabelpilotstudytrial AT osamuyokosukamdphd esophagealmotilityandrikkunshitotreatmentforprotonpumpinhibitorrefractorynonerosiverefluxdiseaseaprospectiveuncontrolledopenlabelpilotstudytrial |