Acotiamide, a novel gastroprokinetic for the treatment of patients with functional dyspepsia: postprandial distress syndrome

Altan, Ege; Masaoka, Tatsuhiro; Farré, Ricard; Tack, Jan

doi:10.1586/egh.12.34

Cited by 47 publications

(31 citation statements)

References 33 publications

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“…And acotiamide has been shown in the mechanistic studies to enhance the gastric emptying rate and gastric accommodation in FD patients [10, 11, 17], whereas no effect of acotiamide on gastric emptying was found within healthy volunteers [15]. However, not all PDS patients receiving acotiamide therapy get symptom relief, probably reflecting the heterogeneous property of this clinical condition [33]. Acotiamide did not significantly improved the symptoms of patients with EPS compared with placebo, possibly for the reason that the pathophysiological mechanisms underlying EPS are different from that of PDS and probably other management approaches are needed for EPS.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Acotiamide for the Treatment of Functional Dyspepsia: Systematic Review and Meta-Analysis

Xiao

Xie²,

Fan

et al. 2014

The Scientific World Journal

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Background. There are no treatments with established efficacy for this disorder so far. Aim. To systematically review the efficacy of acotiamide in the treatment of patients with FD. Methods. We searched main electronic databases through November 2013. RCTs evaluating the efficacy of acotiamide versus placebo in FD patients were included. Pooled risk ratio (RR) with 95% confidential interval (CI) was calculated. Results. Six publications including seven RCTs were eligible for inclusion. The summary RR of overall improvement of FD symptoms in patients receiving acotiamide versus placebo was 1.29 (95% CI, 1.19–1.40, P < 0.00001; I 2 = 15%). Acotiamide improved the symptoms of patients with postprandial distress syndrome (PDS) (RR, 1.29; 95% CI, 1.09–1.53, P = 0.003; I 2 = 0%), and the summary RR for patients with epigastric pain syndrome (EPS) was 0.92 (95% CI, 0.76–1.11, P = 0.39; I 2 = 0%). Acotiamide showed a significantly beneficial effect on the elimination of some individual FD symptoms compared with placebo. Adverse events were not significantly different between acotiamide and placebo groups. Subgroup analyses suggested that acotiamide 100 mg three times daily (tid) showed consistent efficacy not only for the overall improvement but also for the elimination of some individual symptoms in FD patients. Conclusions. Acotiamide has the potential to improve the symptoms of patients with FD, particularly of patients with PDS, without major adverse effects. The dosage of acotiamide 100 mg tid might be the appropriate dose in the treatment of FD.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Acotiamide for the Treatment of Functional Dyspepsia: Systematic Review and Meta-Analysis

Xiao

Xie²,

Fan

et al. 2014

The Scientific World Journal

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“…However, in our data, acotiamide treatment did not significantly improved lower GI tract symptoms. Previous studies have reported that acotiamide enhances acetylcholine release from enteric neurons through muscarinic receptor antagonism and acetylcholineesterase inhibition, thereby enhancing gastric emptying and gastric accommodation [26,27]. Nagahama et al have reported that oral administration of acotiamide stimulated postprandial gastroduodenal and colonic motor activities in conscious dogs [28].…”

Section: Discussionmentioning

confidence: 99%

Impact of Acotiamide Affects Meal-related Symptoms and Lower Abdominal Symptoms in Functional Dyspepsia in Japan

Yanagawa¹,

Futagami²,

Shimpuku³

et al. 2014

Int J Gastroenterol Disord Ther

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Background: To clarify whether acotiamide improve postprandial distress symptoms and lower abdominal symptoms through affecting hypothalamic-pituitary-adrenal (HPA) axis in FD patients. Methods: We used Rome III criteria to evaluate upper and lower abdominal symptoms. Twenty-five functional dyspepsia (FD) patients were treated with acotiamide (300mg/day) for 4 weeks. Anxiety was evaluated using STAI-state/-trait. We measured ACTH and cortisol levels in FD patients. Results: Acotiamide treatment significantly (p=0.007, p=0.003) improved postprandial fullness and early satiety in 4 weeks treatment in FD patients compared to those in pretreatment. In contrast, acotiamide treatment improved lower abdominal symptoms, while insignificantly. Acotiamide did not also affect anxiety using STAI-state/-trait. Acotiamide treatment for 4 weeks did not affect ACTH and cortisol levels in FD patients. Conclusion: Further studies will be needed to clarify how acotiamide improve clinical symptoms in FD patients.

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“…Acotiamide is an antagonist of the inhibitory muscarinic type 1 and type 2 (M1/M2) autoreceptors on cholinergic nerve endings, and is also a cholinesterase inhibitor [28]. Through these actions, acotiamide enhances the availability of synaptically released acetylcholine, thereby enhancing reflex-controlled motility.…”

Section: Pharmacotherapymentioning

confidence: 99%

Therapeutic Options for Functional Dyspepsia

Vanheel¹,

Tack²

2014

Dig Dis

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Functional dyspepsia (FD) is defined by the presence of chronic gastroduodenal symptoms in the absence of organic or systemic disease that explains them, and a negative upper endoscopy. According to the Rome III consensus, FD can be subdivided into PDS (postprandial distress syndrome) and EPS (epigastric pain syndrome). In patients with mild symptoms, reassurance and lifestyle adjustments are often sufficient. Pharmacotherapy, for those with more severe or persisting symptoms, includes the use of proton pump inhibitors (PPIs), prokinetics and psychotropic agents. In those diagnosed with Helicobacter pylori infection, eradication is recommended, although the symptom impact is often limited. PPIs are the initial therapy of choice for EPS, while prokinetics can be used in PDS. Tricyclic antidepressants can be used for refractory symptoms, especially in EPS. Emerging therapies include the novel gastroprokinetic agent acotiamide for PDS, fundus-relaxing 5-HT_1A agonists in patients with PDS/early satiation and mirtazapine for FD with weight loss.

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Acotiamide, a novel gastroprokinetic for the treatment of patients with functional dyspepsia: postprandial distress syndrome

Cited by 47 publications

References 33 publications

Efficacy and Safety of Acotiamide for the Treatment of Functional Dyspepsia: Systematic Review and Meta-Analysis

Efficacy and Safety of Acotiamide for the Treatment of Functional Dyspepsia: Systematic Review and Meta-Analysis

Impact of Acotiamide Affects Meal-related Symptoms and Lower Abdominal Symptoms in Functional Dyspepsia in Japan

Therapeutic Options for Functional Dyspepsia

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