Yamawaki H, Futagami S, Kawagoe T, Maruki Y, Hashimoto S, Nagoya H, Sato H, Kodaka Y, Gudis K, Akamizu T, Sakamoto C, Iwakiri K
Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
The First Department of Medicine, Wakayama Medical University, Wakayama, Japan.
Neurogastroenterol Motil. 2016 Jul;28(7):1037-47. doi: 10.1111/nmo.12805. Epub 2016 Feb 27.
The aim of this study is to clarify whether acotiamide and rabeprazole combination therapy can improve clinical symptoms, gastric emptying, and satisfaction with treatment in functional dyspepsia (FD) patients more effectively than acotiamide or rabeprazole monotherapy alone. We also aimed to determine whether acotiamide affects these changes via its effect on gastric emptying and appetite-related hormones such as ghrelin.
We used Rome III criteria to evaluate upper abdominal symptoms and anxiety by the State-Trait Anxiety Inventory (STAI). Gastric motility was evaluated by the (13) C-acetate breath test. Eighty-one FD patients were treated with acotiamide (300 mg/day) (n = 35), acotiamide (300 mg/day) and rabeprazole (10 mg/day) (n = 28), or rabeprazole (10 mg/day) (n = 18) for a period of 4 weeks and followed after 4 weeks of no treatment. Adenocorticotropic hormone (ACTH), cortisol, leptin and ghrelin levels were measured in all FD patients.
Acotiamide and rabeprazole combination therapy significantly improved postprandial distress syndrome (PDS)-like symptoms (p = 0.018, p = 0.04 and p = 0.041, respectively) and epigastric pain (p = 0.024) as wells as STAI-state scores (p = 0.04) compared to rabeprazole monotherapy. Both acotiamide monotherapy, and acotiamide taken in combination with rabeprazole, significantly (p = 0.001 and p = 0.02, respectively) improved satisfaction with treatment, compared to rabeprazole monotherapy. Acotiamide and rabeprazole combination therapy had no significant effect on ACTH and cortisol levels in FD patients. Of interest, acotiamide monotherapy, and acotiamide and rabeprazole combination therapy, significantly (p < 0.0001 and p = 0.018, respectively) increased acylated ghrelin/total ghrelin ratios and significantly (p = 0.04) improved impaired gastric emptying compared to rabeprazole monotherapy.
CONCLUSIONS & INFERENCES: Further studies are warranted to clarify how acotiamide treatment improves clinical symptoms in FD patients.
本研究旨在阐明阿考替胺与雷贝拉唑联合治疗相比单独使用阿考替胺或雷贝拉唑单药治疗，是否能更有效地改善功能性消化不良（FD）患者的临床症状、胃排空及治疗满意度。我们还旨在确定阿考替胺是否通过影响胃排空及胃饥饿素等食欲相关激素来影响这些变化。
我们采用罗马Ⅲ标准通过状态-特质焦虑量表（STAI）评估上腹部症状及焦虑情况。通过¹³C-醋酸呼气试验评估胃动力。81例FD患者接受阿考替胺（300毫克/天）治疗（n = 35）、阿考替胺（300毫克/天）与雷贝拉唑（10毫克/天）联合治疗（n = 28）或雷贝拉唑（10毫克/天）治疗（n = 18），为期4周，在4周未治疗后进行随访。测定所有FD患者的促肾上腺皮质激素（ACTH）、皮质醇、瘦素及胃饥饿素水平。
与雷贝拉唑单药治疗相比，阿考替胺与雷贝拉唑联合治疗显著改善了餐后不适综合征（PDS）样症状（分别为p = 0.018、p = 0.04和p = 0.041）、上腹部疼痛（p = 0.024）以及STAI状态评分（p = 0.04）。与雷贝拉唑单药治疗相比，阿考替胺单药治疗以及阿考替胺与雷贝拉唑联合治疗均显著提高了治疗满意度（分别为p = 0.001和p = 0.02）。阿考替胺与雷贝拉唑联合治疗对FD患者的ACTH和皮质醇水平无显著影响。有趣的是，与雷贝拉唑单药治疗相比，阿考替胺单药治疗以及阿考替胺与雷贝拉唑联合治疗均显著提高了酰化胃饥饿素/总胃饥饿素比值（分别为p < 0.0001和p = 0.018），并显著改善了受损的胃排空（p = 0.04）。
有必要进一步研究以阐明阿考替胺治疗如何改善FD患者的临床症状。
