Therapeutic effect of Wendan Decoction combined with mosapride on gastroesophageal reflux disease after esophageal cancer surgery

BACKGROUND

Gastroesophageal reflux disease (GERD) is a common complication of esophageal cancer surgery that can affect quality of life and increase the risk of esophageal stricture and anastomotic leakage. Wendan Decoction (WDD) is a traditional Chinese herbal formula used to treat various gastrointestinal disorders, such as gastritis, functional dyspepsia, and irritable bowel syndrome. Mosapride, a prokinetic agent, functions as a selective 5-hydroxytryptamine 4 agonist, enhancing gastrointestinal motility.

AIM

To evaluate the therapeutic effects of WDD combined with mosapride on GERD after esophageal cancer surgery.

METHODS

Eighty patients with GERD were randomly divided into treatment (receiving WDD combined with mosapride) and control (receiving mosapride alone) groups. The treatment was conducted from January 2021 to January 2023. The primary outcome was improved GERD symptoms as measured using the reflux disease questionnaire (RDQ). The secondary outcomes were improved esophageal motility (measured using esophageal manometry), gastric emptying (measured using gastric scintigraphy), and quality of life [measured via the Short Form-36 (SF-36) Health Survey].

RESULTS

The treatment group showed a notably reduced RDQ score and improved esophageal motility parameters, such as lower esophageal sphincter pressure, peristaltic amplitude, and peristaltic velocity compared to the control group. The treatment group showed significantly higher gastric emptying rates and SF-36 scores (in both physical and mental domains) compared to the control group. No serious adverse effects were observed in either group.

CONCLUSION

WDD combined with mosapride is an effective and safe therapy for GERD after esophageal cancer surgery. It can improve GERD symptoms, esophageal motility, gastric emptying, and the quality of life of patients. Further studies with larger sample sizes and longer follow-up periods are required to confirm these findings.

Mosapride stimulates human 5-HT4-serotonin receptors in the heart

Mosapride (4-amino-5-chloro-2-ethoxy-N-[[4-[(4-fluorophenyl) methyl]-2-morpholinyl]-methyl] benzamide) is a potent agonist at gastrointestinal 5-HT4 receptors. Mosapride is an approved drug to treat several gastric diseases. We tested the hypothesis that mosapride also stimulates 5-HT4 receptors in the heart. Mosapride increased the force of contraction and beating rate in isolated atrial preparations from mice with cardiac overexpression of human 5-HT4-serotonin receptors (5-HT4-TG). However, it is inactive in wild-type mouse hearts (WT). Mosapride was less effective and potent than serotonin in raising the force of contraction or the beating rate in 5-HT4-TG. Only in the presence of cilostamide (1 μM), a phosphodiesterase III inhibitor, mosapride, and its primary metabolite time dependently raised the force of contraction under isometric conditions in isolated paced human right atrial preparations (HAP, obtained during open heart surgery). In HAP, mosapride (10 μM) reduced serotonin-induced increases in the force of contraction. Mosapride (10 µM) shifted the concentration-response curves to serotonin in HAP to the right. These data suggest that mosapride is a partial agonist at 5-HT4-serotonin receptors in HAP.

Clinical Trial: Efficacy of Mosapride Controlled-release and Nortriptyline in Patients With Functional Dyspepsia: A Multicenter, Double-placebo, Double-blinded, Randomized Controlled, Parallel Clinical Study

Background/Aims

Prokinetic agents and neuromodulators are among the treatment options for functional dyspepsia (FD), but their comparative efficacy is unclear. We aimed to compare the efficacy of mosapride controlled-release (CR) and nortriptyline in patients with FD after 4 weeks of treatment.

Methods

Participants with FD were randomly assigned (1:1) to receive mosapride CR (mosapride CR 15 mg and nortriptyline placebo) or nortriptyline (mosapride CR placebo and nortriptyline 10 mg) in double-placebo, double-blinded, randomized controlled, parallel clinical study. The primary endpoint was defined as the proportion of patients with overall dyspepsia improvement after 4 weeks treatment. The secondary endpoints were changes in individual symptom scores, anxiety, depression, and quality of life.

Results

One hundred nine participants were recruited and assessed for eligibility, and 54 in the mosapride CR group and 50 in the nortriptyline group were included in the modified intention-to-treat protocol. The rate of overall dyspepsia improvement was similar between groups (53.7% vs 54.0%, P = 0.976). There was no difference in the efficacy of mosapride CR and nortriptyline in a subgroup analysis by FD subtype (59.3% vs 52.5% in postprandial distress syndrome, P = 0.615; 44.4% vs 40.0% in epigastric pain syndrome, P = > 0.999; 50.0% vs 59.1% in overlap, P = 0.565; respectively). Both treatments significantly improved anxiety, depression, and quality of life from baseline.

Conclusion

Mosapride CR and nortriptyline showed similar efficacy in patients with FD regardless of the subtype. Both treatments could be equally helpful for improving quality of life and psychological well-being while also relieving dyspepsia.

The role of mosapride and levosulpiride in gut function and glycemic control in diabetic rats

BACKGROUND AND STUDY AIMS

Gastroparesis is a well-known consequence of long-standing diabetes that presents with gastric dysmotility in the absence of gastric outlet obstruction. This study aimed to evaluate the therapeutic effects of mosapride and levosulpiride on improving gastric emptying in type 2 diabetes mellitus (T2DM) while regulating glycemic levels.

MATERIAL AND METHODS

Rats were divided into the normal control, untreated diabetic, metformin-treated (100 mg/kg/day), mosapride-treated (3 mg/kg/day), levosulpiride-treated (5 mg/kg/day), metformin (100 mg/kg/day) + mosapride (3 mg/kg/day)-treated, and metformin (100 mg/kg/day) + levosulpiride (5 mg/kg/day)-treated diabetic groups. T2DM was induced by a streptozotocin-nicotinamide model. Fourweeks from diabetes onset, the treatment was started orally daily for 2 weeks. Serum glucose, insulin, and glucagon-like peptide 1 (GLP-1) levels were measured. Gastric motility study was performed using isolated rat fundus and pylorus strip preparations. Moreover, the intestinal transit rate was measured.

RESULTS

Mosapride and levosulpiride administration showed a significant decrease in serum glucose levels with improvement of gastric motility and intestinal transit rate. Mosapride showed a significant increase in serum insulin and GLP-1 levels. Metformin with mosapride and levosulpiride co-administration showed better glycemic control and gastric emptying than either drug administered alone.

CONCLUSION

Mosapride and levosulpiride showed comparable prokinetic effects. Metformin administration with mosapride and levosulpiride showed better glycemic control and prokinetic effects. Mosapride provided better glycemic control than levosulpiride. Metformin + mosapride combination provided superior glycemic control and prokinetic effects.

Altered Intestinal Permeability and Drug Repositioning in a Post-operative Ileus Guinea Pig Model

Background/Aims

The aim of this study is to identify the alteration in intestinal permeability with regard to the development of post-operative ileus (POI). Moreover, we investigated drug repositioning in the treatment of POI.

Methods

An experimental POI model was developed using guinea pigs. To measure intestinal permeability, harvested intestinal membranes of the ileum and proximal colon was used in an Ussing chamber. To identify the mechanisms associated with altered permeability, we measured leukocyte count and expression of calprotectin, claudin-1, claudin-2, and mast cell tryptase. We compared control, POI, and drug groups (mosapride [0.3 mg/kg and 1 mg/kg, orally], glutamine [500 mg/kg, orally], or ketotifen [1 mg/kg, orally] with regard to these parameters.

Results

Increased permeability after surgery significantly decreased after administration of mosapride, glutamine, or ketotifen. Leukocyte counts increased in the POI group and decreased significantly after administration of mosapride (0.3 mg/kg) in the ileum, and mosapride (0.3 mg/kg and 1 mg/kg), glutamine, or ketotifen in the proximal colon. Increased expression of calprotectin after surgery decreased after administration of mosapride (0.3 mg/kg), glutamine, or ketotifen in the ileum and proximal colon, and mosapride (1 mg/kg) in the ileum. The expression of claudin-1 decreased significantly and that of claudin-2 increased after operation. After administration of glutamine, the expression of both proteins was restored. Finally, mast cell tryptase levels increased in the POI group and decreased significantly after administration of ketotifen.

Conclusions

The alteration in intestinal permeability is one of the factors involved in the pathogenesis of POI. We repositioned 3 drugs (mosapride, glutamine, and ketotifen) as novel therapeutic agents for POI.

Clinical effects of Lactobacillus acidophilus combined with mosapride in treatment of gastrointestinal dysfunction after craniocerebral injury

BACKGROUND

Most patients with severe craniocerebral injury have gastrointestinal motility deficiency. When the body is exposed to external mechanical trauma, infection, vomiting, and gastric content reflux tend to occur, which causes early gastrointestinal dysfunction, affects nutrient intake, aggravates brain edema, delays wound healing, and is not conducive to the prognosis of patients. Mosapride is a commonly used gastrointestinal motility agent, which can improve gastrointestinal motility and speed up gastric emptying. Lactobacillus acidophilus can regulate the intestinal flora, protect the intestinal mucosal barrier, maintain intestinal balance, and relieve gastric motility. The purpose of this study was to investigate the effects of Lactobacillus acidophilus combined with mosapride treatment on the time to reach enteral nutrition standards, intestinal flora, rehabilitation process, and other aspects of patients with gastrointestinal dysfunction after craniocerebral injury, and to evaluate its clinical effects.

AIM

To observe the clinical effects of Lactobacillus acidophilus combined with mosapride in the treatment of gastrointestinal dysfunction after craniocerebral injury.

METHODS

A total of 92 patients with gastrointestinal dysfunction after craniocerebral injury at our hospital from February 2018 to February 2021 were selected and divided into a study group and a control group at a ratio of 1:1 using a random number table, with 46 cases in each group. On the basis of conventional treatment, the control group was given mosapride, and the study group was given Lactobacillus acidophilus combined with mosapride for 1 wk. The clinical efficacy, time to reach enteral nutrition standards, recovery progress, 28-d mortality rate, gastric motility indexes [intra-abdominal pressure (IAP) and residual gastric volume (GRA)], and intestinal motility before treatment and after 3 d and 1 wk of treatment were compared between the two groups. Intestinal barrier function indexes [D-lactic acid (D-LA) and diamine oxidase (DAO)] and intestinal flora (Bifidobacterium, Lactobacillus, Enterococcus, and Enterobacter) were also compared.

RESULTS

The total effective rate of the study group was higher than that of the control group (93.48% vs 78.26%, P < 0.05). The time to reach enteral nutrition standards, time to mechanical ventilation, and the length of ICU stay in the study group were shorter than those of the control group (P < 0.05). There was no significant difference in the 28-d mortality rate between the two groups (P > 0.05). The APACHE II and SOFA scores of the study group were lower than those of the control group after 3 d and 1 wk of treatment, and the Glasgow Coma scale scores were higher than those of the control group (P < 0.05). The levels of IAP, GRA, D-LA, and DAO in the study group were lower than those of the control group after 3 d and 1 wk of treatment (P < 0.05). The numbers of Bifidobacterium and Lactobacillus in the study group were more than those of the control group after 3 d and 1 wk of treatment, and the numbers of Enterococcus and Enterobacter were less than those of the control group (P < 0.05).

CONCLUSION

Lactobacillus acidophilus and mosapride are effective in treating gastrointestinal dysfunction after craniocerebral injury. They can shorten the time to reach enteral nutrition standards, adjust the intestinal flora, protect the intestinal mucosal barrier, promote the recovery of the gastrointestinal tract and nerve function, and accelerate the recovery process of patients.

Multicenter, Randomized, Placebo-controlled Trial to Evaluate the Efficacy and Safety of a Controlled-release, Once-daily UIC201609/UIC201610 Combination Therapy for Functional Dyspepsia: Preliminary Study

Backgrounds/Aims

Functional dyspepsia is a disease involving a range of upper gastrointestinal symptoms derived from various pathophysiologies. Tablets containing a combination of rabeprazole and controlled-release (CR) mosapride were recently developed. To investigate a more effective treatment, this trial evaluated the efficacy and safety of UIC201609/UIC201610 as a preliminary study.

Methods

A multicenter, double-blind, randomized study was performed on 30 subjects. UIC201609/UIC201610 (combination of rabeprazole and CR mosapride) was the case group, and the two control groups were rabeprazole 10 mg once a day and mosapride 15 mg CR tablet once a day. As a primary efficacy endpoint of the study, the changes in the total score of eight items of the Nepean Dyspepsia Index-Korean version were analyzed at 2 weeks and 4 weeks. The outcomes regarding safety were collected.

Results

The total symptom score of Nepean Dyspepsia Index-Korean decreased in the rabeprazole single group (29.4±17.1), mosapride CR single group (33.4±15.6), and UIC201609/UIC201610 group (33.4±11.8) at 4 weeks without significant differences. On the other hand, the UIC201609/UIC201610 combination group showed more score reduction of pain in the upper abdomen, burning in the upper abdomen compared to each control group, but it did not reach statistical significance. No difference was found in safety analysis.

Conclusions

UIC201609/UIC201610 once daily showed some improvement in epigastric pain and dyspepsia in patients with functional dyspepsia, but there was no significance. Further study based on the advanced clinical trial design will be needed to confirm the efficacy of UIC201609/UIC201610 combination therapy in the future.

Efficacy and Safety of DWJ1252 Compared With Gasmotin in the Treatment of Functional Dyspepsia: A Multicenter, Randomized, Double-blind, Active-controlled Study

Background/Aims

Prokinetics such as mosapride citrate CR (conventional-release; Gasmotin) are commonly used in functional dyspepsia (FD). This study aims to evaluate the efficacy and safety of once-a-day mosapride citrate SR (DWJ1252), a sustained-release formulation of mosapride citrate, compared with mosapride citrate CR 3 times a day, in patients with FD.

Methods

In this multicenter, randomized, double-blind, active-controlled, non-inferiority study, 119 patients with FD (by the Rome III criteria, 60 for mosapride citrate SR and 59 for mosapride citrate CR) were randomly allocated to mosapride citrate SR once daily or mosapride citrate CR thrice daily for 4 weeks in 16 medical institutions. Primary end point was the change in gastrointestinal symptom (GIS) score from baseline, assessed by GIS questionnaires on 5-point Likert scale after 4-week treatment. Secondary end points and safety profiles were also analyzed.

Results

The study included 51 and 49 subjects in the mosapride citrate SR and mosapride citrate CR groups, respectively. GIS scores at week 4 were significantly reduced in both groups (mean ± SD: -10.04 ± 4.45 and -10.86 ± 5.53 in the mosapride citrate SR and mosapride citrate CR groups, respectively; P < 0.001), and the GIS changes from baseline did not differ between the 2 groups (difference, 0.82 point; 95% CI, -1.17, 2.81; P = 0.643). Changes in GIS at weeks 2 and 4 and quality of life at week 4, and the improvement rates of global assessments at weeks 2 and 4, did not differ between the groups. Adverse events were similar in the 2 groups, and there were no serious adverse events.

Conclusion

In patients with FD, mosapride citrate SR once daily is as effective as mosapride citrate CR thrice daily, with a similar safety profile.

Mosapride Improves Lower Esophageal Sphincter and Esophageal Body Function in Patients With Minor Disorders of Esophageal Peristalsis

Background/Aims

High-resolution manometry (HRM) has broadened the awareness of minor esophageal peristaltic disorders. However, the treatments for these minor disorders are limited and the role of prokinetics has been controversial. This study evaluates the effect of mosapride in patients with minor peristaltic disorders.

Methods

This study prospectively enrolled 21 patients with esophageal symptoms who were diagnosed with minor peristaltic disorders by gastroscopy and HRM using the Chicago classification version 3.0. Patients received mosapride 30 mg daily for 2 weeks. Symptoms were assessed using the abbreviated World Health Organization quality of life scale (WHOQOL-BREF) and a HRM study was performed before and after 2 weeks of treatment.

Results

HRM metrics of lower esophageal sphincter (LES) respiratory mean pressure (median 14.6 mmHg vs 17.3 mmHg; interquartile range [IQR] 8.7-22.5 mmHg vs 12.5-25.9 mmHg; P = 0.004) and distal contractile integral (median 343.8 mmHg·sec·cm vs 698.1 mmHg·sec·cm; IQR 286.5-795.9 mmHg·sec·cm vs 361.0-1127.6 mmHg·sec·cm; P = 0.048) were significantly increased after treatment. Complete response (≥ 80.0%), satisfactory response (≥ 50.0%), partial response (< 50.0%), and refractory response rates were 19.0%, 52.4%, 14.3%, and 14.3%, respectively. However, there was no statistical difference in all WHOQOL-BREF scores before and after treatment. Univariate analysis showed LES respiratory mean pressure (P = 0.036) was associated with symptom improvement (complete + satisfactory group). However, no statistical difference was found in other factors after multivariate analysis.

Conclusions

Mosapride improved esophageal symptoms and significantly increased LES respiratory mean pressure and distal contractile integral. Therefore, mosapride could enhance LES and esophageal body contraction pressures in patients with minor peristaltic disorders.

[Treatment of postprandial discomfort syndrome in the elderly: a multi-centered prospective randomized controlled clinical study]

Objective: To evaluate the efficacy and safety of Oryz-Aspergillus enzyme and pancreatin tablets (Combizym(®)) in the treatment of postprandial distress syndrome (PDS) in the elderly, compared with gastrointestinal motility drugs. Methods: A prospective randomized controlled trial was designed and registered in the China Clinical Trials Registry (ChiCTR-IPR-16008185). The elderly patients with PDS were randomly divided into three groups, including Mosapride group with Mosapride citrate tablets 5 mg 3 times per day for 2 weeks; Combizym(®) group with Combizym tablets 244 mg 3 times per day for 2 weeks; combined treatment group with both drugs and same doses for 2 weeks. The modified Nepean dyspepsia index (NDSI) score, discomfort intensity score and PDS score were calculated on patients before treatment, at the end of first and second week of treatment, as well as 4 weeks after treatment finished, respectively. Adverse effects were evaluated. Results: A total of 323 patients from 16 tertiary hospitals in China were enrolled in this study. Among them, 105 patients were in Mosapride group, 109 in Combizym(®) group and 109 in combined treatment group. There were 148 males (45.8%) and 175 females (54.2%) with median age 71.4±9.0 years (60-100 years). Baseline characteristics of three groups were comparable. After treatment, the NDSI scores in three groups all decreased significantly (P<0.001), while they were similar between groups (P>0.05). The discomfort intensity score and PDS score in three groups showed a significant reduction after treatment (P<0.001), especially in the combined treatment group. Compared with Mosapride group, the scores in Combizym(®) group decreased significantly after one or two weeks [discomfort intensity score: after one week, 4.0(2.5, 8.0) vs. 6.0(3.0, 10.0); after two weeks, 3.0(0.0, 5.0) vs. 4.0(2.0, 6.0); all P<0.05. PDS score: after one week, 6.0(3.0, 9.0) vs. 7.0(3.5, 10.5); after two weeks, 3.0(0.0, 5.0) vs. 4.0(2.0, 7.0); all P<0.05]. The efficacy rate in all patients after first week of treatment was over 15.0%. The efficacy rates after two weeks were 55.2%, 68.8% and 73.4% in Mosapride group, Combizym(®) group and combined treatment group, respectively. After two week treatment, the efficacy rates in Combizym(®) group (P=0.041) and combined group (P=0.006) were higher than that of Mosapride group. The recurrence rate of Mosapride group was 9.5%, which was significantly higher than that of Combizym(®) group (1.8%, P<0.05) and combined treatment group (1.8%, P<0.05). There were no serious adverse effects in the three groups. Conclusions: The efficacy of Oryz-Aspergillus enzyme and pancreatin tablets is comparable with that of Mosapride in elderly PDS patients, with fewer adverse effects and low recurrence rate. Combination regimen indicates better efficacy than that of Oryz-Aspergillus enzyme and pancreatin tablets or Mosapride alone.

Gastroprokinetic agent, mosapride inhibits 5-HT3 receptor currents in NCB-20 cells

Mosapride accelerates gastric emptying by acting on 5-hydroxytryptamine type 4 (5-HT₄) receptor and is frequently used in the treatment of gastrointestinal (GI) disorders requiring gastroprokinetic efficacy. We tested the effect of mosapride on 5-hydroxytryptamine type 3 (5-HT₃) receptor currents because the 5-HT₃ receptors are also known to be expressed in the GI system and have an important role in the regulation of GI functions. Using the whole-cell voltage clamp method, we compared the currents of the 5-HT₃ receptors when 5-HT was applied alone or was co-applied with mosapride in cultured NCB-20 cells known to express 5-HT₃ receptors. The 5-HT₃ receptor current amplitudes were inhibited by mosapride in a concentration-dependent manner. Mosapride blocked the peak currents evoked by the application of 5-HT in a competitive manner because the EC₅₀ shifted to the right without changing the maximal effect. The rise slopes of 5-HT₃ receptor currents were decreased by mosapride. Pre-application of mosapride before co-application, augmented the inhibitory effect of mosapride, which suggests a closed channel blocking mechanism. Mosapride also blocked the opened 5-HT₃ receptor because it inhibited the 5-HT₃ receptor current in the middle of the application of 5-HT. It accelerated desensitization of the 5-HT₃ receptor but did not change the recovery process from the receptor desensitization. There were no voltage-, or use-dependency in its blocking effects. These results suggest that mosapride inhibited the 5-HT₃ receptor through a competitive blocking mechanism probably by binding to the receptor in closed state, which could be involved in the pharmacological effects of mosapride to treat GI disorders.

The tissue distribution and excretion study of mosapride and its active des-p-fluorobenzyl and 4'-N-oxide metabolites in rats by ultra-high performance liquid chromatography-tandem mass spectrometry method

1. Mosapride is a potent gastroprokinetic agent, and des-p-fluorobenzyl mosapride (M1) and mosapride-N-oxide (M2) are its two major active metabolites.2. The validated ultra-high performance liquid chromatography-tandem mass spectrometry method was successfully applied to the distribution and excretion of mosapride and its two active metabolites.3. Mosapride and its metabolites were distributed widely and rapidly in various tissues. The highest concentration of mosapride and M2 in both male and female rats was found in the duodenum, followed by cecum.4. The excretion study showed that a total of 71.8% (37.6, 22.4 and 11.8% for urine, feces and bile, respectively) and 66.3% (35.7, 22.8 and 7.8% for urine, feces and bile) of administered dose was recovered from male and female excreta. M1 was excreted in the largest dose percentage, followed by mosapride and M2, and the total cumulative excretion amounts were about 36.9, 28.1 and 11.6% in male rat, while 24.3, 25.9 and 16.2% in female rat. The results demonstrated for the first time that M2 is one of the important excretion forms of mosapride, which is much higher than that of mosapride in urine.5. This work could provide valuable information for further pharmacological and clinical studies of mosapride.

Efficacy and Safety of UI05MSP015CT in Functional Dyspepsia: A Randomized, Controlled Trial

Background/Aims

To evaluate the efficacy and safety of a controlled release, once-daily formulation of mosapride (UI05MSP015CT) in patients with functional dyspepsia (FD).

Methods

Patients with FD were randomly assigned (1:1) to receive either UI05MSP015CT (15 mg once a day, study group) or mosapride (5 mg three times a day, control group) and corresponding placebo for 4 weeks. The primary endpoint was a change in the gastrointestinal symptom score (GIS) evaluated at enrollment and after 4 weeks. Secondary endpoints were changes in the Nepean Dyspepsia Index-Korean version (NDI-K), rate of satisfactory symptom relief, and rate of adverse events.

Results

A total of 138 patients were enrolled (female, 73.9%; mean age, 44.0±15.4 years). After excluding patients who violated the study protocol, 59 and 58 patients from the study and control groups, respectively, were included in the per-protocol analysis. No difference was observed in drug compliance between the control and study groups (97.07%±4.52% vs 96.85%±6.05%, p=0.870). Changes in GIS scores were -9.69±6.44 and -10.01±5.92 in the study and control groups. The mean difference in GIS change between groups was 0.33 (95% confidence interval, -1.75 to 2.41), demonstrating non-inferiority of UI-05MSP015CT (p=0.755). The rate of satisfactory symptom relief was not different between the study and control groups (39.0% vs 56.9%, p=0.053). No differences in change in NDI-K score (14.3 vs 16.9, p=0.263) or rates of adverse events (12.9% vs. 4.4%, p=0.062) were observed between the study and control groups.

Conclusions

Once-daily mosapride is not inferior to conventional mosapride in efficacy and is safe in patients with FD.

Symmetrical Drug-Related Intertriginous and Flexural Exanthema: Two Cases and Brief Literature Review

It has been reported that there are a range of causative drugs related to symmetrical drug-related intertriginous and flexural exanthema (SDRIFE). The causative drugs reported so far include the following: antibiotics, intravenous immunoglobulin, chemotherapeutic agents, and biologics. In this study, we report two cases of SDRIFE and a review of the previous literature. We believe that our study makes a significant contribution to the literature because it demonstrates that intradermal injection of the Chinese herbal ball, and not its topical application, elicited a reaction that predicted the occurrence of SDRIFE. This finding is important for the diagnosis of SDRIFE in future studies. Our findings also provide evidence for a SDRIFE reaction after exposure to ranitidine and mosapride.

Clinical efficacy and safety of alpha-lipoic acid combined with mosapride in treatment of diabetic gastroparesis

AIM

To evaluate the clinical efficacy and safety of alpha-lipoic acid combined with mosapride in the treatment of diabetic gastroparesis.

METHODS

Ninety-two patients with diabetic gastroparesis treated at our hospital from August 2015 to February 2017 were randomly divided into either an observation group or a control group, with 46 cases in each group. Both groups were given conventional treatment and mosapride, and the observation group was additionally given alpha lipoic acid. After 2 wk of treatment, the curative effect, gastric motilin, gastric emptying, and adverse reactions were compared between the two groups.

RESULTS

The total effective rate was significantly higher in the observation group than in the control group (93.48% vs 84.78%, P < 0.05). Before treatment, there was no difference in gastric motilin or gastric emptying rate between the two groups. After treatment, both groups showed a significant decrease in gastric activity and a significant increase in gastric emptying rate (P < 0.05), and the changes were more significant in the observation group (P < 0.05). The incidence of adverse reactions in the observation group was significantly lower than in the control group (4.35% vs 13.04%, P < 0.05).

CONCLUSION

Alpha-lipoic acid combined with mosapride has remarkable clinical efficacy in treating diabetic gastroparesis, and can promote gastric emptying and correct gastrointestinal hormones, with few adverse reactions.

Mosapride Stabilizes Intestinal Microbiota to Reduce Bacterial Translocation and Endotoxemia in CCl4-Induced Cirrhotic Rats

BACKGROUND

Impaired intestinal motility may lead to the disruption of gut microbiota equilibrium, which in turn facilitates bacterial translocation (BT) and endotoxemia in cirrhosis. We evaluated the influence of mosapride, a prokinetic agent, on BT and DNA fingerprints of gut microbiota in cirrhotic rats.

METHODS

A rat model of cirrhosis was set up via subcutaneous injection of carbon tetrachloride (CCl₄). The portal pressure, liver and intestinal damage, plasma endotoxin, BT, and intestinal transit rate (ITR) of cirrhotic rats were determined. Fecal DNA fingerprints were obtained by ERIC-PCR. The expressions of tight junction proteins were evaluated by western blotting.

RESULTS

Mosapride treatment to cirrhotic rats significantly reduced the plasma endotoxin level and incidence of BT, accompanied by increased ITR. Cirrhotic rats (including those treated with mosapride) suffered from BT exhibited significantly lower ITR than those who are free of BT. Pearson coefficient indicated a significant and negative correlation between the plasma endotoxin level and ITR. The genomic fingerprints of intestinal microbiota from the three groups fell into three distinctive clusters. In the mosapride-treated group, Shannon's index was remarkably increased compared to the model group. Significantly positive correlation was detected between Shannon's index and ITR. Mosapride did not improve hepatic and intestinal damages and ileal expressions of occludin and ZO-1.

CONCLUSIONS

Mosapride significantly increases intestinal motility in cirrhotic rats, thus to recover the disordered intestinal microbiota, finally resulting in decreased plasma endotoxin and BT.

Curative effect of mosapride vs prucalopride in treatment of chronic constipation in elderly patients

AIM: To compare the curative effect between mosapride and prucalopride in the treatment of chronic constipation in elderly patients.

METHODS: From February 2013 to September 2014, 123 elderly patients with chronic constipation at our department were randomly assigned to orally receive either mosapride (control group, n = 61) or prucalopride (observation group, n = 62). The efficacy, time to first defecation, and time to improvement of difficult defecation were compared between the two groups. Moreover, the scores for common symptoms (defecation frequency, stool properties, defecation difficulty and defecation time) and adverse reactions were also recorded.

RESULTS: The total effective rate in the observation group was 83.61% (59/62), significantly higher than that of the control group [83.61% (51/61), P < 0.05]. Compared with the control group, the time to first defecation and time to improvement of difficult defecation were shortened, and common symptom scores decreased in the observation group (P < 0.05). Main adverse reactions included diarrhea, nausea and abdominal pain, and the duration of these adverse reactions was shorter. There was no statistical significance in the incidence of adverse reactions between the two groups (P > 0.05).

CONCLUSION: Prucalopride has a better curative effect than mosapride in the treatment of elderly patients with chronic constipation in terms of improved symptoms and tolerable adverse reactions.

Mosapride, a selective serotonin 5-HT4 receptor agonist, and alogliptin, a selective dipeptidyl peptidase-4 inhibitor, exert synergic effects on plasma active GLP-1 levels and glucose tolerance in mice

Pharmacologic stimulation of serotonin 5-HT4 receptors increased plasma active glucagon-like-peptide-1 (GLP-1) levels independent of feeding, and that pharmacologic stimulation of 5-HT4 receptors and pharmacologic inhibition of dipeptidyl peptidase-4 exerted synergic effects on plasma active GLP-1 levels and glucose tolerance in mice.

Efficacy of mosapride and pantoprazole in treatment of children with functional dyspepsia

AIM: To compare the efficacy and safety of mosapride and pantoprazole in the treatment of children with functional dyspepsia.

METHODS: Sixty children with functional dyspepsia were selected and randomly divided into either an observation group or a control group, with 30 cases in each group. Subjects in the observation group were treated with mosapride (5 mg, po, tid). Subjects in the control group were treated with pantoprazole (40 mg, po, qd). After 2 wk of treatment, the symptom score and clinical efficacy of the two groups were observed and compared.

RESULTS: After treatment, the scores of total symptoms, abdominal fullness after meals, early satiety, epigastric pain, and epigastric burning sensation in the two groups were significantly lower than those before the treatment (observation group: 14.39 ± 7.13 vs 20.79 ± 11.36, 4.39 ± 1.37 vs 4.84 ± 5.16, 3.89 ± 1.19 vs 4.17 ± 4.43, 3.74 ± 1.05 vs 6.37 ± 5.36, 3.95 ± 1.98 vs 6.73 ± 6.21; control group: 13.57 ± 6.42 vs 20.68 ± 11.41, 3.27 ± 1.16 vs 4.91 ± 5.21, 3.16 ± 1.08 vs 4.20 ± 4.52, 4.29 ± 1.23 vs 6.29 ± 5.83, 4.17 ± 1.54 vs 6.82 ± 6.08; P < 0.05 for all). The scores of total symptoms, abdominal fullness after meals, early satiety, epigastric pain, and epigastric burning sensation after treatment showed no significant differences between the two groups (P > 0.05 for all). The difference in the total response rate between the two groups was not statistically significant (70.00% vs 66.67%, P > 0.05). There were no significant differences in the response rates for postprandial distress syndrome and epigastric pain syndrome between the two groups (70.59% vs 64.71%, 69.23% vs 69.23%, P > 0.05 for both).

CONCLUSION: Both mosapride and pantoprazole have good efficacy in the treatment of children with functional dyspepsia.

Clinical effects of mosapride plus ranitidine vs mosapride plus rabeprazole for treatment of esophageal reflux laryngitis

AIM: To investigate the clinical effects of mosapride plus rabeprazole in patients with esophageal reflux laryngitis.

METHODS: One hundred and thirty esophageal reflux laryngitis patients treated at the Affiliated People's Hospital of Hubei Medical College from July 2011 to July 2014 were randomly divided into either a control group to receive mosapride plus ranitidine or a study group to receive mosapride and rabeprazole, with 65 cases in each group. The total response rate, percentage of time with pH < 4, and clinical symptom score were compared for the two groups.

RESULTS: The total response rate was significantly higher in the study group than in the control group (95.38% vs 67.69%, P < 0.05). After treatment, percentage of time with pH < 4 and clinical symptom score were significantly improved in both groups compared with pretreatment values, and the improvement was more significant in the study group than in the control group (P < 0.05). There was no significant difference between the two groups in the incidence of adverse reactions (P > 0.05).

CONCLUSION: Mosapride plus rabeprazole has a significant therapeutic effect in treating esophageal reflux laryngitis, and the combination therapy can reduce symptoms and has high safety.

Clinical effects of esomeprazole combined with mosapride for treatment of gastroesophageal reflux disease

AIM: To explore the clinical effects of esomeprazole combined with mosapride in the treatment of gastroesophageal reflux disease.

METHODS: One hundred and sixteen patients with gastroesophageal reflux disease were randomly divided into either an observation group or a control group. The observation group was treated by esomeprazole combined with mosapride, and the control group was treated by esomeprazole alone. The scores of gastroesophageal reflux disease-Q (GERD-Q), the rate of Helicobacter pylori (H. pylori) infection and the effective rate were compared for the two groups.

RESULTS: The scores of GERD-Q at 2, 4, and 8 wk post treatment were lower than that prior treatment (15.80 ± 2.32, 11.80 ± 1.88, 10.94 ± 1.32 vs 19.23 ± 2.75; 17.02 ± 2.06, 13.52 ± 1.77, 11.41 ± 1.46 vs 19.56 ± 2.55; P < 0.05). There were no significant differences in the scores of GERD-Q among different time points (19.23 ± 2.75 vs 19.56 ± 2.55, 15.80 ± 2.32 vs 17.02 ± 2.06, 11.80 ± 1.88 vs 13.52 ± 1.77, 10.94 ± 1.32 vs 11.41 ± 1.46, P > 0.05). The effective rate for the observation group was significantly higher than that for the control group (82.76% vs 65.52%, P < 0.05). The rates of H. pylori infection post treatment for the two groups were lower than those prior treatment (17.24% vs 48.28%, 24.14% vs 50.00%, P < 0.05). There was no significant difference in the rate of H. pylori infection post treatment between the two groups (17.24% vs 24.14%, P > 0.05).

CONCLUSION: Esomeprazole combined with mosapride has good clinical effects in the treatment of gastroesophageal reflux disease with regards to improved effective rate, scores of GERD-Q, and reduced rate of H. pylori infection.

Effect of mosapride combined with esomeprazole in non-erosive reflux disease patients

AIM: To evaluate the effect of mosapride combined with esomeprazole in the treatment of non-erosive reflux disease (NERD).

METHODS: Eighty patients with NERD treated from January 2011 to March 2014 were randomly and equally divided into two groups: and observation group and a control group. The observation group was treated with mosapride and esomeprazole for 8 wk, and the control group was treated with omeprazole and domperidone for 8 wk. Before and 8 wk after treatment, gastroesophageal reflux disease questionnaire (Gerd Q) survey and high-resolution esophageal manometry (including lower esophageal sphincter pressure and clearance ability of distal esophageal body) were performed, and clinical effects were compared between the two groups.

RESULTS: After treatment, Gerd Q scores in both the observation group and control group were significantly lower than pretreatment scores (9.8 ± 2.5 vs 7.0 ± 2.0; 10.1 ± 2.1 vs 8.3 ± 2.2; P < 0.05), and Gerd Q score was significantly lower in the observation group than in the control group (P < 0.05). The total effective rate was significantly higher in the observation group than in the control group (92.5% vs 72.5%, P < 0.05). Lower esophageal sphincter pressures in both groups were significantly increased after treatment (20.88 mmHg ± 3.91 mmHg vs 12.13 mmHg ± 5.89 mmHg; 17.59 mmHg ± 5.18 mmHg vs 11.85 mmHg ± 6.32 mmHg; P < 0.05), and the increase was more significant in the observation group (P < 0.05). The amplitude of the distal esophageal body in the observation group was significantly higher than pretreatment value (72.70 mmHg ± 29.37 mmHg vs 65.85 mmHg ± 25.53 mmHg, P < 0.05), and the posttreatment value in the control group (72.70 mmHg ± 29.37 mmHg vs 65.85 mmHg ± 25.53 mmHg, P < 0.05). The rates of effective contraction in both groups were significantly increased after treatment (92.5% vs 62.5%; 85.0% vs 65.0%; P < 0.05), and the increase was more significant in the observation group (P < 0.05).

CONCLUSION: Mosapride combined with esomeprazole can improve clinical symptoms (including reflux, heartburn and retrosternal pain), and increase the lower esophageal sphincter pressure and the clearance ability of diatal esophageal body in NERD patients.

Rabeprazole sodium combined with mosapride and ursodeoxycholic acid for treatment of reflux esophagitis in Han, Hui and Tibetan patients

AIM: To investigate the clinical efficacy of rabeprazole sodium combined with mosapride and ursodeoxycholic acid in the treatment of reflux esophagitis (RE) in patients of different ethnicity.

METHODS: From January 2013 to June 2014, Han, Hui and Tibetan patients (n = 60 for each ethnicity) with RE were treated with rabeprazole sodium, mosapride and ursodeoxycholic acid. After 8 wk of treatment, clinical symptoms were observed, and gastroscopy examination was performed.

RESULTS: After 8 wk of treatment, clinical symptoms were significantly reduced in all the three groups of patients; the total response rate had no statistical difference among the three group (95.00% vs 91.67% vs 93.33%, P > 0.05); and no serious adverse reactions were observed in any group.

CONCLUSION: Rabeprazole sodium combined with mosapride and ursodeoxycholic acid has good therapeutic effects on RE in Han, Hui and Tibetan patients.

Efficacy and safety of pantoprazole sodium enteric-coated tablets combined with mosapride in treatment of functional dyspepsia

AIM: To assess the efficacy and safety of pantoprazole sodium enteric-coated tablets (Pan) combined with mosapride citrate tablets (Mosa) in the treatment of functional dyspepsia (FD).

METHODS: This was a prospective parallel controlled trial. One hundred and forty-nine FD patients were randomly divided into either an observation group (n = 75) or a control group (n = 74). The observation group was given Mosa plus Pan, and the control group was given Maso alone. Clinical effects were compared for the two groups.

RESULTS: The total response rate was significantly higher in the observation group than in the control group (96% vs 83.78%, χ² = 6.1398, P = 0.0132). The incidence of adverse reactions was significantly lower in the observation group than in the control group (16% vs 29.73%, χ² = 3.9868, P = 0.0459). The recurrence rates at 1, 3 and 6 mo were lower in the observation group than in the control group (8.0% vs 9.46%, 17.33% vs 21.62%, 24% vs 41.89%, and the difference at 6 mo was significant (χ² = 5.4025, P = 0.0201). At 1, 3 and 6 mo, the functional digestive disorder quality of life questionnaire (FDDQL) scores and scale total scores were significantly higher in the observation group than in the control group (P < 0.05).

CONCLUSION: Pan combined with Mosa has better curative effect and higher safety than Mosa alone in the treatment of FD.

Curative effect of Biantong capsules combined with mosapride in treatment of constipation after hemorrhoid surgery in elderly patients

AIM: To assess the curative effect of Biantong capsules combined with mosapride in the treatment of constipation in elderly patients after hemorrhoid surgery.

METHODS: Seventy-eight elderly patients with constipation who had undergone hemorrhoid surgery at Nanyang Central Hospital were randomly divided into either an observation group or a control group (n = 39 for each). The observation group was treated with Biantong capsules plus mosapride, and the control group was treated with mosapride alone. The curative effect was compared between the two groups.

RESULTS: Two patients in the observation group developed loose stool, which was relieved after continued treatment. Six patients in the control group developed abdominal pain, which was resolved after enema administration. No liver function abnormalities were observed in either group. In the observation group, 26 (66.7%) cases were cured, 7 (17.9%) cases showed a significant response, 4 (10.3%) cases showed a partial response, and 2 (5.1%) cases showed no response; the corresponding figures in the control group were 17 (43.6%), 4 (10.3%), 10 (25.9%) and 8 (20.5%), respectively. The total response rate was significantly higher in the treatment group than in the control group (94.9% vs 79.5%, P < 0.05).

CONCLUSION: Biantong capsules combined with mosapride has a good curative effect in the treatment of constipation in elderly patients after hemorrhoid surgery.

The 5-hydroxytryptamine 4 Receptor Agonist-induced Actions and Enteric Neurogenesis in the Gut

We explored a novel effect of 5-hydroxytryptamine 4 receptor (5-HT₄R) agonists in vivo to reconstruct the enteric neural circuitry that mediates a fundamental distal gut reflex. The neural circuit insult was performed in guinea pigs and rats by rectal transection and anastomosis. A 5-HT₄R-agonist, mosapride citrate (MOS) applied orally and locally at the anastomotic site for 2 weeks promoted the regeneration of the impaired neural circuit or the recovery of the distal gut reflex. MOS generated neurofilament-, 5-HT₄R- and 5-bromo-2'-deoxyuridine-positive cells and formed neural network in the granulation tissue at the anastomosis. Possible neural stem cell markers increased during the same time period. These novel actions by MOS were inhibited by specific 5-HT₄R-antagonist such as GR113808 (GR) or SB-207266. The activation of enteric neural 5-HT₄R promotes reconstruction of an enteric neural circuit that involves possibly neural stem cells. We also succeeded in forming dense enteric neural networks by MOS in a gut differentiated from mouse embryonic stem cells. GR abolished the formation of enteric neural networks. MOS up-regulated the expression of mRNA of 5-HT₄R, and GR abolished this upregulation, suggesting MOS differentiated enteric neural networks, mediated via activation of 5-HT₄R. In the small intestine in H-line: Thy1 promoter green fluorescent protein (GFP) mice, we obtained clear 3-dimensional imaging of enteric neurons that were newly generated by oral application of MOS after gut transection and anastomosis. All findings indicate that treatment with 5-HT₄R-agonists could be a novel therapy for generating new enteric neurons to rescue aganglionic disorders in the whole gut.

Efficacy of mosapride plus proton pump inhibitors for treatment of gastroesophageal reflux disease: A systematic review

AIM: To assess the potential benefits of mosapride plus proton pump inhibitors (PPIs) in the treatment of gastroesophageal reflux disease.

METHODS: A literature search was performed through MEDLINE, EMBASE, and the ISI Web of Knowledge. The clinical trials that compared the benefit of mosapride plus PPI treatment with that of PPI monotherapy were analyzed. The rate of responders was evaluated by the pooled relative risk (PRR) and improvement in symptom scores was assessed by single effect size of a standardized mean, while Hedges’g was used as the effect size. Pooled effect sizes with 95%CIs were calculated using a fixed-effects model. Between-study heterogeneity was assessed using Q test and I² analyses. In addition, studies that assessed the additional efficacy of mosapride in PPI-resistant patients were also reviewed.

RESULTS: This systematic review included information on a total of 587 patients based on 7 trials. Four trials compared the efficacy of combination therapy of mosapride plus a PPI with that of PPI monotherapy. The statistical analysis for the effect of additional mosapride showed equivocal results (PRR = 1.132; 95%CI: 0.934-1.372; P = 0.205; Hedges’g = 0.24; 95%CI: 0.03-0.46; P = 0.023). No heterogeneity and publication bias were found among the studies. Three open-labeled trials assessed the additional efficacy of mosapride in PPI-resistant patients. However, since these trials did not set the control group, the results may be considerably biased.

CONCLUSION: Mosapride combined therapy is not more effective than PPI alone as first-line therapy. Whether it is effective in PPI-resistant patients needs to be determined.

Effect of mosapride on capsule endoscopy: A systematic review of randomized controlled trials

AIM: To assess the effect of mosapride on capsule endoscopy.

METHODS: We searched Cochrane Central Register of Controlled Trails (CENTRAL), MEDLINE or PubMed, and Chinese VIP database. The bibliographies of retrieved articles and correlated proceedings were also searched manually. A systematic review was conducted using the method recommended by the Cochrane Collaboration.

RESULTS: Seven trials involving 500 patients were included in the systematic review. Meta-analysis showed that mosapride was superior to the blank control in terms of gastric emptying time (P < 0.00001), small-bowel transit time (P < 0.00001) and the completion rate of small bowel examination (P < 0.00001); however, mosapride was not superior to the blank control in the diagnostic yield (P = 0.05).

CONCLUSION: The limited current evidence shows that mosapride decreases gastric emptying time and improves the completion rate of total small-bowel examination in patients undergoing capsule endoscopy. However, all these findings should be interpreted with caution and more clinical trials are needed.

Effects of the Addition of Mosapride to Gastroesophageal Reflux Disease Patients on Proton Pump Inhibitor: A Prospective Randomized, Double-blind Study

Background/Aims

Proton pump inhibitors (PPIs) which are the most effective agents for the treatment of gastroesophageal reflux disease (GERD), have been known to delay gastric emptying. Mosapride has been used as prokinetics by accelerating gastric emptying. We evaluated the efficacy of mosapride to prevent PPI-induced delayed gastric emptying in a prospective randomized, double-blind and placebo-controlled trial.

Methods

Thirty patients who were diagnosed as GERD and had normal gastric emptying were included in this study. PPI monotherapy group was treated with placebo drug in addition to pantoprazole and PPI plus mosapride group was treated with mosapride in addition to pantoprazole for 8 weeks. Gastric emptying scan and questionnaires about GERD and dyspeptic symptoms were assessed by scoring before and after treatment. To evaluate the changes of gastrointestinal endocrine hormones by PPI which are associated gastric acid secretion and gastric motility, fasting plasma gastrin and cholecystokinin were taken at weeks 0 and 8.

Results

Half gastric emptying time was increased (P = 0.023) in PPI monotherapy group, and there were no significant changes in PPI plus mosapride group. Plasma gastrin level increased in PPI monotherpay group (P = 0.028) and there were no significant changes in PPI plus mosapride group. Plasma cholecystokinin level was not changed after treatment in both groups. GERD symptoms were improved after treatment in both groups, and postprandial bloating and nausea were improved in PPI plus mosapride group.

Conclusions

Mosapride showed to be effective in preventing delayed gastric emptying and the increase in plasma gastrin level induced by PPI treatment, but did not show prominent clinical symptom improvements.

Role of mosapride in improvement of bowel preparation before colonoscopy in patients with constipation

AIM: To investigate the role of mosapride in improvement of bowel preparation before colonoscopy in patients with constipation.

METHODS: Ninety patients with chronic constipation who requested colonoscopy were randomly and equally divided into three groups: A, B and C. Group A was given polyethylene glycol solution, group B was treated by mosapride plus polyethylene glycol solution, and group C was given mosapride alone. The extent of intestinal cleanliness and the incidence of side effects were compared between the three groups.

RESULTS: The colon cleaning score was significantly higher in groups C and B than in group A (7.13 ± 1.12, 6.65 ± 1.18 vs5.81 ± 1.19, both P < 0.05). The frequency of bowel movement in group C was significantly higher than that in group A (7.15 ± 1.61 vs 6.54 ± 1.52, t = 2.724, P = 0.023). The intestinal bubble score showed no statistically significant difference among the three groups (F = 0.359, P = 0.699). The incidence of side effects also did not differ significantly among the three groups (16.67%, 13.33% and 6.67%, χ² = 1.450, P = 0.484).

CONCLUSION: Mosapride can effectively improve bowel preparation before colonoscopy in patients with constipation.

Bowel preparation prior to colonoscopy: a continual search for excellence

Bowel preparation prior to colonoscopy is essential to maximize the benefits of colonoscopy. Numerous bowel preparations have been studied, ranging from 4 L polyethylene glycol (PEG) to split-dose regimens to 2 L PEG with an adjunct laxative (senna, bisacodyl, ascorbic acid). Due to the large volume of PEG required for adequate bowel preparation, many studies have focused on reducing this large volume to only 2 L PEG with the addition of an adjunct. Recently, a randomized controlled trial by Tajika et al showed that the addition of mosapride to only 1.5 L PEG was non-inferior to mosapride and 2 L PEG for bowel cleansing but did provide improvements in patient tolerance. This study offers yet another potential bowel preparation for patients undergoing colonoscopy and may trigger further studies with 1.5 L PEG with an adjunct. In this letter, we discuss the current state of bowel preparation prior to colonoscopy and offer information to guide clinicians on choosing the appropriate bowel preparation for their patients.

Mosapride protects against clopidogrel-induced gastric mucosal epithelium cell damage via the p38 MAPK signaling pathway

AIM: To investigate whether mosapride has a protective effect against clopidogrel-induced gastric mucosal epithelium cells (GES-1) damage and to explore the underlying mechanisms.

METHODS: GES-1 cells were cultured in vitro and divided into control group, clopidogrel group (treated with clopidogrel at a concentration of IC50, 0.36 mmol/L) and clopidogrel plus mosapride groups (treated with clopidogrel and 0.4, 0.5, or 0.6 µmol/L of mosapride). MTT assay and flow cytometry were used to detect the proliferation and apoptosis of cells of each group. The expression of phosphorylated P38 (p-P38), occludin and ZO-1 proteins in GES-1 cells was detected by Western blot.

RESULTS: Compared to the control group, p-P38 expression was significantly up-regulated in the clopidogrel group (P < 0.05). The expression of p-P38 in the clopidogrel plus mosapride groups was significantly lower than that in the clopidogrel group (all P < 0.05). With the decrease in p-P38 expression, the expression of occludin and ZO-1 were gradually increased.

CONCLUSION: Mosapride exerts a protective effect against clopidogrel-induced GES-1 cell damage probably by inhibiting p38/MAPK phosphorylation and up-regulating the expression of tight junction proteins occludin and ZO-1.

Electrogastrography associated with symptomatic changes after prokinetic drug treatment for functional dyspepsia

AIM: To evaluate the effect of prokinetic drugs on electrogastrography (EGG) parameters according to symptomatic changes in patients with functional dyspepsia (FD).

METHODS: Seventy-four patients with FD were prospectively enrolled in this study between December 2006 and December 2010. We surveyed the patients using a questionnaire on dyspeptic symptoms before and after an 8-wk course of prokinetic drug treatment. We also measured cutaneous pre-prandial and post-prandial EGG recordings including percentage of gastric waves (normogastria, bradygastria, tachygastria), dominant frequency (DF), dominant power (DP), dominant frequency instability coefficient (DFIC), dominant power instability coefficient (DPIC), and the ratio of post-prandial to fasting in DP before and after the 8-wk course of prokinetic drug treatment.

RESULTS: Fifty-two patients (70%) achieved symptomatic improvement after prokinetic drug treatment. Patients who had normal gastric slow waves showed symptom improvement group after treatment. Post-prandial DF showed a downward trend in the symptom improvement group, especially in the itopride group. Post-prandial DP was increased regardless of symptom improvement, especially in the itopride group and mosapride group. Post-prandial DFIC and DPIC in the symptom improvement group were significantly increased after the treatment. The EGG power ratio was increased after treatment in the symptom improvement group (0.50 ± 0.70 vs 0.93 ± 1.77, P = 0.002), especially in the itopride and levosulpiride groups.

CONCLUSION: Prokinetics could improve the symptoms of FD by regulating gastric myoelectrical activity, and EGG could be a useful tool in evaluating the effects of various prokinetics.

Effects of the oral administration of mosapride citrate on capsule endoscopy completion rate

Background/Aims

In capsule endoscopy (CE), the capsule does not always reach the cecum within its battery life, which may reduce its diagnostic yield. We evaluated the effect of mosapride citrate, a 5-hydroxytryptamine-4 agonist that increases gastrointestinal motility, on CE completion.

Methods

In a retrospective study, we performed univariate and multivariate analyses for 232 CE procedures performed at our hospital. To identify factors that affect CE completion, the following data were systematically collected: gender, age, gastric transit time (GTT), nonsteroidal anti-inflammatory drug administration, previous abdominal surgery, hospitalization, use of a polyethylene glycol solution, use of mosapride citrate (10 mg), body mass index (BMI), and total recording time.

Results

The univariate analysis showed that oral mosapride citrate, GTT, and BMI were associated with improved CE completion. Multivariate analyses showed that oral mosapride citrate (odds ratio [OR], 1.99; 95% confidence interval [CI], 1.01 to 3.91) and GTT (OR, 2.34; 95% CI, 1.13 to 4.87) were significant factors for improving the CE completion. Oral mosapride citrate significantly shortened the GTT and small bowel transit time (SBTT).

Conclusions

Oral mosapride citrate reduced the GTT and SBTT during CE and improved the CE completion rate.

Mixed 5-HT3 antagonists/5-HT4 agonists for irritable bowel syndrome: a systematic review

AIM: To systematically review the evidence for the efficacy and safety of mixed 5-HT₃ antagonists/5-HT₄ agonists in the treatment of irritable bowel syndrome (IBS).

METHODS: According to the recommendations of the Cochrane Collaboration, a meta-analysis was conducted on 2 841 patients from eight eligible trials with respect to the usage of these drugs.

RESULTS: The unimprovement in IBS global symptoms [42.7% vs 46.9%, RR = 0.91, 95% CI (0.58, 1.43)], abdominal pain [53.2% vs 59.3%, RR = 0.90, 95% CI (0.72, 1.11)] or constipation [54.0% vs 58.5%, RR = 0.91, 95%CI (0.74, 1.12)] did not differ significantly in the presence of cisapride vs placebo. In the presence of renzapride, lower doses (1 mg/d and 2 mg/d) were found not to be superior to placebo in attenuating global symptoms [RR = 0.95, 95% CI (0.67, 1.35); RR = 0.79, 95% CI (0.67, 1.17)]; however, high dose of renzapride (4 mg/d) resulted in a significant difference [67.8 % vs 73.9%, RR = 0.91, 95% CI (0.86, 0.96)]. There was no significant difference in the incidence of adverse events among cisapride [RR = 1.52, 95% CI (0.58, 3.99)], renzapride [RR = 1.11, 95% CI (0.98, 1.24)] and placebo.

CONCLUSION: Except for high dose of renzapride (4 mg/d) which could relieve the global symptoms in IBS-C patients, there was no sufficient evidence to indicate that low dose renzapride or cisapride might be used to improve the global symptoms, abdominal pain as well as constipation discomfort.

Mosapride accelerates the delayed gastric emptying of high-viscosity liquids: a crossover study using continuous real-time C breath test (BreathID System)

Background/Aims

The administration of liquid nutrients to patients is often accompanied by complications such as gastroesophageal reflux. To prevent gastroesophageal reflux, high-viscosity liquid meals are used widely, however, it still remains controversial whether high-viscosity liquid meals have any effect on the rate of gastric emptying. The present study was conducted with the aim of determining whether high-viscosity liquid meals had any effect on the rate of gastric emptying and mosapride might accelerate the rate of gastric emptying of high-viscosity liquid meals.

Methods

Six healthy male volunteers underwent 3 tests at intervals of > 1 week. After fasting for > 8 hours, each subject received one of three test meals (liquid meal only, high-viscosity liquid meal [liquid meal plus pectin] only, or high-viscosity liquid meal 30 minutes after intake of mosapride). A ¹³C-acetic acid breath test was performed, which monitored the rate of gastric emptying for 4 hours. Using the Oridion Research Software (β version), breath test parameters were calculated. The study parameters were examined for all the 3 test conditions and compared using the Freidman test.

Results

Gastric emptying was significantly delayed following intake of a high-viscosity liquid meal alone as compared with a liquid meal alone; however, intake of mosapride prior to a high-viscosity liquid meal was associated with a significantly accelerated rate of gastric emptying as compared with a high-viscosity liquid meal alone.

Conclusions

This study showed that high-viscosity liquid meals delayed gastric emptying: however, mosapride recovered the delayed rate of gastric emptying by high-viscosity liquid meals.

Effects of gastrokinetic agents on human sphincter of Oddi motility

AIM: To observe the effects of domperidone, mosapride and tegaserod on the motility of human sphincter of Oddi (SO) and to analyze potential mechanisms involved.

METHODS: Thirty-two patients with T-tube drainage after choledochotomy were randomly divided into three groups: domperidone group, mosapride group and tegaserod group. The pressure of the SO was measured with a choledochofiberscope via T-tube fistula. Agents were given sublingually. Basic pressure of the SO (SOBP), amplitude of the SO (SOCA), duration of phasic contractions (SOD), duodenal pressure (DP), and common bile duct pressure (CBDP) were recorded and analyzed.

RESULTS: SOBP and SOCA decreased markedly not only in the domperidone group (10.30 ± 4.99 vs 6.40 ± 3.66; 110.52 ± 37.80 vs 68.67 ± 41.02; both P < 0.05) but also in the mosapride group (2.56 ± 13.02 vs 6.00 ± 5.74; 83.44 ± 46.16 vs 52.48 ± 44.19; both P < 0.05). SOBP and SOCA did not change after tegaserod intake. No significant changes in SOF, SOD and CBDP were noted in all the groups.

CONCLUSION: Both domperidone and mosapride at clinical doses decrease SOBP and SOCA and inhibit SO motility, while tegaserod at clinical dose does not affect SO motility.

Effect of esomeprazole and mosapride on the esophageal motility dysfunction in elderly patients with hypotensive LES: an analysis of 29 cases

AIM: To investigate the therapeutic effect of esomeprazole and mosapride on aged hypotensive type LES esophageal motility dysfunction.

METHODS: A total of 57 aged hypotensive type LES esophageal motility dysfunction patients were divided into treatment group (n = 29) and control group (n = 28). Patients in treatment group were given esomeprazole 20 mg per day and mosapride 5 mg three times daily for 1 mo while patients in control group were given mosapride 5 mg three times daily for 1 mo. After medication treatment, the clinical symptoms, lower esophageal sphincter (LES) pressure and esophageal motility were observed.

RESULTS: Fifty seven cases of patients completed the study. The total effective rate of treatment group was 86.2%, which was significantly higher than that of control group (60.7%). LES pressure was improved significantly in both groups (1.82 ± 0.36 vs 1.09 ± 0.18, P < 0.001; 1.91 ± 0.45 vs 1.06 ± 0.17, P < 0.001, respectively). Esophageal motility became better in both groups, but no statistical difference was observed between them after treatment(48.3% vs 53.6%, P = 0.193).

CONCLUSION: Esomeprazole and mosapride are effective for aged hypotensive type LES esophageal motility dysfunction.

Advances in roles of prokinetic agents in the treatment of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is characterized by the reflux of gastric content into esophagus with or without histological changes. Pathogenesis of GERD is lower esophageal sphincter (LES) dysfunction, abnormal clearing capacity of refluxed materials, delayed gastric emptying and abnormal resistance of esophageal mucosa to gastric acid, but the primary upper gastrointestinal motility dysfunction is regarded as the most important factor in general. Therefore, prokinetic agents which can restore gastric motility with increasing of LES and esophageal motility have been developed and used frequently in the treatment of GERD. There are several prokinetic agents such as metoclopramide, domperidone, cisapride and mosapride that facilitate acetylcholine release from the enteric cholinergic neurons through a selective 5-HT₄ receptor agonistic action. It is considered that prokinetic agents have the same effect as H2 blocker in the treatment of patients with mild GERD. Additionally, it was reported that a combination therapy with prokinetic agents and proton pump inhibitors (PPI) or H2 receptor antagonists (H2RAs) is more effective than monotherapy in patients with severe GERD. This article reviews the recent advances in the role of prokinetic agents in the treatment of gastroesophageal reflux disease.

Efficacy of esomeprazole, mosapride and lifestyle enhancement in the treatment of non-erosive gastroesophageal reflux disease: an analysis of 58 cases and comparative study

AIM: To investigate the therapeutic effects of lifestyle enhancement on patients with non-erosive gastroesophageal reflux disease (NERD) based on the combined treatment of esomeprazole and mosapride.

METHODS: A total of 112 NERD patients were divided into control group (n = 54) and test group (n = 58). All the patients were given esomeprazole (40 mg, qd) and mosapride (5 mg, tid) for 8 wk. Besides, the lifestyle in test group was enhanced (adjusting lifestyle, diet, mental status and movement intensity). Chi-square test was conducted to compare the efficacy between the two groups.

RESULTS: In the test group, notable efficacy was found in 42 cases, effectivity in 12 cases, and inefficacy in 4 cases and the total effective rate was 93.10% (54/58). In the control group, notable efficacy was observed in 26 cases, effectivity in 18 cases, and inefficacy in 10 cases are ineffective, and the total effective rate was 81.84% (44/54). There was significant difference between the two groups (χ² = 7.39, P < 0.01).

CONCLUSION: On the basis of treatment by esomeprazole and mosapride, lifestyle enhancement can improve the compliance and clinical symptoms of NERD patients.

Efficacy of esomeprazole combined with hydrotalcite and mosapride in treatment of refractory gastroesophageal reflux disease

AIM: To evaluate the effect of esomeprazole combined with hydrotalcite and mosapride on refractory gastroesophageal reflux disease (rGERD).

METHODS: A total of 101 rGERD patients were randomly divided into groups A (n = 36), B B (n = 34) and C (n = 31), treated with esomeprazole plus hydrotalcite plus mosapride, esomeprazole plus mosapride, and hydrotacite plus mosapride, respectively. The clinical outcomes were observed and analyzed after 4 and 8 wk of treatment. Endoscopy was performed to evaluate the effective rate in the three groups.

RESULTS: After 4 wk of treatment, the total improvement rate was significantly higher in group A (88.9%) than that in group B (79.4%) and C (61.3%) (χ² = 7.3531, P < 0.05). Eight weeks after treatment, the total improvement rates were 97.2%, 88.2% and 71.0% in group A, B and C, and the effective rates detected by endoscopy were 94.4%, 85.3% and 67.7%, respectively. The total improvement rate (χ² = 9.6039, P < 0.01) and effective rate (χ² = 8.6496, P < 0.05) were markedly higher in group A than those in B and C group.

CONCLUSION: Esomeprazole combined with hydrotalcite and mosapride may be highly effective in the treatment of rGERD.