Chen Chien-Lin, Yi Chih-Hsun, Liu Tso-Tsai, Orr William C
Department of Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University , Hualien , Taiwan.
Scand J Gastroenterol. 2013 Dec;48(12):1363-70. doi: 10.3109/00365521.2013.840856. Epub 2013 Oct 8.
OBJECTIVE. Ineffective esophageal motility is frequently found in patients with gastroesophageal reflux diseases. Secondary peristalsis contributes to esophageal acid clearance. Mosapride improves gastrointestinal (GI) motility by acting on 5-hydroxytrypatamine4 receptors. The authors aimed to evaluate the effect of mosapride on secondary peristalsis in patients with ineffective esophageal motility. MATERIAL AND METHODS. After recording primary peristalsis baseline, secondary peristalsis was stimulated by slowly and rapidly injecting mid-esophageal air in 18 patients. Two separate experiments were randomly performed with 40 mg oral mosapride or placebo. RESULTS. Mosapride had no effect on the threshold volume of secondary peristalsis during slow air distension (9.8 ± 0.97 vs. 10.2 ± 1.0 mL; p = 0.84), but decreased the threshold volume during rapid air distension (4.1 ± 0.2 vs. 4.6 ± 0.3 mL; p = 0.001). The efficiency of secondary peristalsis during rapid air distension increased with mosapride (70% [40-95%]) compared with placebo (60% [10-85%]; p = 0.0003). Mosapride had no effect on the amplitudes of distal pressure wave of secondary peristalsis during slow (94.3 ± 9 vs. 101.9 ± 9.1 mmHg; p = 0.63) or rapid air distension (89.3 ± 9 vs. 95.2 ± 8.3 mmHg; p = 0.24). CONCLUSIONS. Mosapride improves esophageal sensitivity of secondary peristalsis by abrupt air distension but has limited effect on the motor properties of secondary peristalsis in ineffective esophageal motility patients. Despite its well-known prokinetic effect, mosapride enhances the efficiency of secondary peristalsis in patients with ineffective esophageal motility through augmenting esophageal sensitivity instead of motility.
目的。胃食管反流病患者常出现食管动力障碍。继发性蠕动有助于食管酸清除。莫沙必利通过作用于5-羟色胺4受体改善胃肠动力。作者旨在评估莫沙必利对食管动力障碍患者继发性蠕动的影响。材料与方法。记录原发性蠕动基线后，通过向18例患者食管中段缓慢和快速注入空气来刺激继发性蠕动。随机进行两项独立实验，分别给予40 mg口服莫沙必利或安慰剂。结果。在缓慢充气时，莫沙必利对继发性蠕动的阈值容积无影响（9.8±0.97 vs. 10.2±1.0 mL；p = 0.84），但在快速充气时降低了阈值容积（4.1±0.2 vs. 4.6±0.3 mL；p = 0.001）。与安慰剂（60%[10 - 85%]；p = 0.0003）相比，快速充气时莫沙必利使继发性蠕动的效率提高（70%[40 - 95%]）。在缓慢（94.3±9 vs. 101.9±9.1 mmHg；p = 0.63）或快速充气（89.3±9 vs. 95.2±8.3 mmHg；p = 0.24）时，莫沙必利对继发性蠕动远端压力波的振幅无影响。结论。莫沙必利通过突然充气提高了食管继发性蠕动的敏感性，但对食管动力障碍患者继发性蠕动的运动特性影响有限。尽管莫沙必利具有众所周知的促动力作用，但其通过增强食管敏感性而非动力来提高食管动力障碍患者继发性蠕动的效率。
