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The treatment effects of acotiamide in esophagogastric outflow obstruction: a prospective longitudinal observational study

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Abstract

Objectives

We have found that an altered lower esophageal sphincter (LES) accommodation response is an underlying cause of esophagogastric junction outflow obstruction (EGJOO). The objective of this study was to examine the treatment effect of acotiamide, a prokinetic agent which improves impaired gastric accommodation in functional dyspepsia, in patients with EGJOO.

Methods

A prospective observational longitudinal study was conducted between October 2014 and March 2020. Acotiamide (100 mg, 3 times a day) was administered to 25 patients with EGJOO for 4 weeks. High-resolution manometry (HRM) was performed just before and after 4 weeks of treatment.

Results

As the primary outcome, the extent of integrated relaxation pressure (IRP) after treatment (14.6, 12.1–22.0 mmHg) was significantly lower than that before treatment (19.4, 17.1–27.4 mmHg). The extent of LES accommodation index after treatment (32.7, 21.0–40.0 mmHg) was also significantly lower than that before treatment (39.3, 31.2–50.2 mmHg). Acotiamide normalized the IRP (< 15 mmHg) in 13 of 25 patients with EGJOO (52%), and the IRP was decreased in 20 of 25 patients with EGJOO (80%). As the secondary outcome, the total FSSG score in 25 patients with EGJOO before and after acotiamide treatment showed no significant difference. In a sub-analysis of 13 patients in whom EGJOO was normalized by acotiamide, however, dysphagia was reported to be significantly improved by acotiamide.

Conclusions

Acotiamide has a treatment effect on patients with EGJOO via a reduction in the IRP level through the lowering of both the basal LES pressure and LES accommodation response. Dysphagia is a key symptom to be evaluated and treated in patients with EGJOO.

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Funding

Grant Support: This study was supported in part by the Japan Society for the Promotion of Science KAKENHI (20K08334) and the Project Promoting Clinical Trials for Development of New Drugs and Medical Devices (Japan Medical Association) from the Japan Agency for Medical Research and Development (AMED) (19lk0201088h0001 and 21lk0201144h0001).

Author information

Author notes

  1. Eikichi Ihara and Haruei Ogino have contributed equally to this work.

Authors and Affiliations

  1. Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Eikichi Ihara, Haruei Ogino, Kazumasa Muta, Shohei Hamada, Masafumi Wada, Yoshitaka Hata, Hiroko Ikeda, Xiaopeng Bai, Yosuke Minoda, Mitsuru Esaki, Yoshimasa Tanaka, Takatoshi Chinen & Yoshihiro Ogawa

  2. Department of Gastroenterology and Metabolism, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan

    Eikichi Ihara

Authors
  1. Eikichi Ihara
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  2. Haruei Ogino
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  3. Kazumasa Muta
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  4. Shohei Hamada
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  5. Masafumi Wada
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  6. Yoshitaka Hata
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  8. Xiaopeng Bai
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  13. Yoshihiro Ogawa
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Contributions

EI, HO, and KM designed this study. KM, SH, MW, and HI performed the HRM study. MW, YH, HI, XB, YM, ME and YT performed EGD. KM, SH, MW, YH, YM, and ME collected the data and performed statistical analysis. EI, HO, and ME wrote the manuscript. TC and YO supervised this study and reviewed the manuscript.

Corresponding author

Correspondence to Eikichi Ihara.

Ethics declarations

Ethical statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

Conflict of interest

E.I. belongs to an endowed course supported by the companies including Ono pharmaceutical Co., Ltd., Miyarisan Pharmaceutical Co. Ltd., Sanwa Kagaku Kenkyusho Co., Ltd., Otsuka Pharmaceutical Factory, Inc., Fujifilm Medical Co., Ltd., Terumo corporation, FANCL corporation, Ohga pharmacy, and Abbott Japan, LLC. E.I. receives lecture honorarium from Takeda Pharmaceutical Company. Y.O. conducts collaborative research with Fujifilm Medical Co., Ltd. and FANCL corporation. H.O., K.M., S.H., M.W., Y.H., H.I., X.B.,Y.M., M.E., Y.T., and T.C. declare no conflict of interest in association with this study.

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Ihara, E., Ogino, H., Muta, K. et al. The treatment effects of acotiamide in esophagogastric outflow obstruction: a prospective longitudinal observational study. Esophagus 19, 332–342 (2022). https://doi.org/10.1007/s10388-021-00887-1

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  • DOI: https://doi.org/10.1007/s10388-021-00887-1

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