Improvement of meal-related symptoms and epigasstric pain in patients with functional dyspepsia treated with acotiamide was associated with acylated ghrelin levels in Japan
Improvement of meal-related symptoms and epigasstric pain in patients with functional dyspepsia treated with acotiamide was associated with acylated ghrelin levels in Japan
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在日本，接受阿考酰胺治疗的功能性消化不良患者的进餐相关症状和上腹部疼痛的改善与酰化生长素释放肽水平相关
DOI：
10.1111/nmo.12805
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发表时间：
2016
期刊：
影响因子：
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et al.
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作者：
Yamawaki H;Futagami S;et al.
研究背景本研究的目的是阐明阿考替胺和雷贝拉唑联合治疗功能性消化不良(FD)患者的临床症状、胃排空和对治疗的满意度是否比单用阿考替胺或雷贝拉唑更有效。我们还旨在通过对胃排空和胃肠促性腺激素等食欲相关激素的影响来确定阿科替胺是否影响这些变化。方法我们使用状态-特质焦虑量表(STAI)来评估罗马III标准来评估上腹部症状和焦虑。用13C-乙酸乙酯呼气试验评价胃动力。对81例FD患者分别给予阿考替胺300 mg/d(n=35)、阿考替胺300 mg/d+雷贝拉唑10 mg/d(n=28)或雷贝拉唑10 mg/d(n=18)治疗4周，停药4周后复查。结果与单用雷贝拉唑相比，Acotiamine和雷贝拉唑联合治疗可显著改善餐后窘迫综合征样症状(p=0.018，p=0.04和p=0.041)、上腹痛(p=0.024)和状态评分(p=0.04)。与雷贝拉唑单独治疗相比，单独服用阿考替胺和阿考替胺与雷贝拉唑联合服用均显著提高了治疗满意度(分别为p=0.001和p=0.02)。阿可替胺和雷贝拉唑联合治疗对FD患者的ACTH和皮质醇水平无明显影响。值得注意的是，与雷贝拉唑单药治疗相比，单药治疗和联合治疗可显著提高乙酰化胃促生长素/总胃促生长素比率(p<；0.0001和p=0.018)，并显著改善胃排空障碍。
BackgroundThe 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.MethodsWe used Rome III criteria to evaluate upper abdominal symptoms and anxiety by the State‐Trait Anxiety Inventory (STAI). Gastric motility was evaluated by the13C‐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.Key ResultsAcotiamide and rabeprazole combination therapy significantly improved postprandial distress syndrome (PDS)‐like symptoms (p= 0.018,p= 0.04 andp= 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 andp= 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 andp= 0.018, respectively) increased acylated ghrelin/total ghrelin ratios and significantly (p= 0.04) improved impaired gastric emptying compared to rabeprazole monotherapy.Conclusions & InferencesFurther studies are warranted to clarify how acotiamide treatment improves clinical symptoms in FD patients.