Influence of prucalopride on esophageal secondary peristalsis in reflux patients with ineffective motility

Lei, Wei‐Yi; Hung, Jui‐Sheng; Liu, Tso‐Tsai; Yi, Chih‐Hsun; Chen, Chien‐Lin

doi:10.1111/jgh.13986

Cited by 38 publications

(38 citation statements)

References 37 publications

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“…41,42 To the best of our knowledge, few studies have investigated esophageal motility during long-term acid reflux in individuals with CC and GERD. We found that most primary and secondary peristalsis is 26,47 Our study has several limitations. Less than expected high-extent reflux was detected, this discrepancy possibly being attributable to the high position of impedance loops (26 cm above the LES being defined as high extent in our study as compared with 15 cm above the LES being considered proximal, but not high-extent reflux in a previous study).…”

Section: Discussionmentioning

confidence: 82%

“…The results of monitoring provided strong evidence that proton pump inhibitors (PPIs) are the optimal therapy for patients with GERD‐CC and cough caused by reflux, that is, adequate doses of more potent PPIs and prolonged treatment are indicated. As for reflux caused by cough, comprehensive antitussive measures might be more effective than overuse of PPIs whereas, if available, a prokinetic (ie, mosapride or prucalopride) may be indicated for patients with esophageal dysmotility (ie, IEM) …”

Section: Discussionmentioning

confidence: 99%

“…Esophageal peristalsis was identified as primary or secondary peristalsis according to its association with swallowing during ambulatory pressure monitoring. Primary peristalsis is peristalsis induced by swallowing and transporting of boluses inside the esophagus, whereas secondary peristalsis is triggered by various intra‐esophageal stimuli (ie, refluxate in this study) in the absence of swallowing . In this study, we identified those peristalsis as primary in which the bolus entry at each specific level obtained at the 50% point between 3 seconds pre‐swallow impedance baseline and impedance nadir during bolus presence and bolus exit determined as return to this 50% point on the impedance‐recovery curve .…”

Section: Methodsmentioning

confidence: 97%

“…Primary peristalsis is peristalsis induced by swallowing and transporting of boluses inside the esophagus, whereas secondary peristalsis is triggered by various intra-esophageal stimuli (ie, refluxate in this study) in the absence of swallowing. 25,26 In this study, we identified those peristalsis as primary in which the bolus F I G U R E 1 Positions of electrodes of the ambulatory pHimpedance-pressure monitoring system. Red spot: pH electrodes; grey loop: impedance electrodes; black spot: pressure sensors.…”

Section: Esophageal Motility and Coughmentioning

confidence: 99%

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Gastroesophageal reflux disease and chronic cough: A possible mechanism elucidated by ambulatory pH‐impedance‐pressure monitoring

Lin

Wang

et al. 2019

Neurogastroenterology Motil

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BackgroundThe pathophysiological mechanism(s) of gastroesophageal reflux disease (GERD)‐related chronic cough (CC) is unclear. We aimed to determine the mechanism of reflux‐induced cough by synchronous monitoring of reflux episodes, esophageal motility, and cough.MethodsPatients with GERD were prospectively enrolled and classified into GERD with CC (GERD‐CC) and without CC (GERD) groups. Twenty‐four‐hour ambulatory pH‐impedance‐pressure monitoring was performed; the reflux patterns, esophageal motility during prolonged exposure to acid and characteristics of reflux episodes that induced coughing paroxysms were analyzed.Key ResultsThirty‐one patients with GERD‐CC and 47 with GERD were enrolled; all of whose monitoring results fulfilled the criteria for diagnosis of GERD. Patients with GERD‐CC had higher reflux symptom scores, longer exposure to acid, higher DeMeester scores, and more frequent reflux episodes, proximal extent reflux detected by impedance, and higher percentage of strongly acidic reflux than patients in the GERD group (all P < .05). Of 63 reflux‐cough episodes identified in the GERD‐CC group, 74.6% of distal reflux and 67.0% of proximal reflux episodes were acidic. More patients had low pan‐esophageal pressure in primary peristalsis (48.5% vs 11.8%, P = .000) and synchronous contraction in secondary peristalsis during prolonged exposure to acid in the GERD‐CC than in the GERD group (63.9% vs 9.1%, P = .000).Conclusions & InferencesProximal acidic reflux and distal reflux‐reflex are jointly associated with reflux‐induced cough in patients with GERD. Low pan‐esophageal pressure in primary peristalsis and synchronous contraction in secondary peristalsis may play important roles in GERD‐associated chronic cough.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 97%

Section: Esophageal Motility and Coughmentioning

confidence: 99%

See 2 more Smart Citations

Gastroesophageal reflux disease and chronic cough: A possible mechanism elucidated by ambulatory pH‐impedance‐pressure monitoring

Lin

Wang

et al. 2019

Neurogastroenterology Motil

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“…19 A recent study also revealed that another 5-HT 4 receptor agonist, prucalopride, significantly increased pressure wave amplitude and the peristaltic success rate in patients with IEM. 20 A double-blind, randomized study in healthy volunteers reported that buspirone (5-HT 1A and 5-HT 2 receptor agonists), bethanechol, and pyridostigmine (a cholinesterase inhibitor) significantly enhanced mean DEA and mean LES residual pressure. 8 Therefore, it is presumed that prokinetic agents could be used to treat minor disorders of peristalsis by enhancing esophageal motility.…”

Section: Discussionmentioning

confidence: 99%

Mosapride Improves Lower Esophageal Sphincter and Esophageal Body Function in Patients With Minor Disorders of Esophageal Peristalsis

Kim

Park

et al. 2020

J Neurogastroenterol Motil

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Background/Aims High-resolution manometry (HRM) has broadened the awareness of minor esophageal peristaltic disorders. However, the treatments for these minor disorders are limited and the role of prokinetics has been controversial. This study evaluates the effect of mosapride in patients with minor peristaltic disorders. Methods This study prospectively enrolled 21 patients with esophageal symptoms who were diagnosed with minor peristaltic disorders by gastroscopy and HRM using the Chicago classification version 3.0. Patients received mosapride 30 mg daily for 2 weeks. Symptoms were assessed using the abbreviated World Health Organization quality of life scale (WHOQOL-BREF) and a HRM study was performed before and after 2 weeks of treatment. Results HRM metrics of lower esophageal sphincter (LES) respiratory mean pressure (median 14.6 mmHg vs 17.3 mmHg; interquartile range [IQR] 8.7-22.5 mmHg vs 12.5-25.9 mmHg; P = 0.004) and distal contractile integral (median 343.8 mmHg•sec•cm vs 698.1 mmHg•sec•cm; IQR 286.5-795.9 mmHg•sec•cm vs 361.0-1127.6 mmHg•sec•cm; P = 0.048) were significantly increased after treatment. Complete response (≥ 80.0%), satisfactory response (≥ 50.0%), partial response (< 50.0%), and refractory response rates were 19.0%, 52.4%, 14.3%, and 14.3%, respectively. However, there was no statistical difference in all WHOQOL-BREF scores before and after treatment. Univariate analysis showed LES respiratory mean pressure (P = 0.036) was associated with symptom improvement (complete + satisfactory group). However, no statistical difference was found in other factors after multivariate analysis. Conclusions Mosapride improved esophageal symptoms and significantly increased LES respiratory mean pressure and distal contractile integral. Therefore, mosapride could enhance LES and esophageal body contraction pressures in patients with minor peristaltic disorders.

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Neurochemical classification of serotonin‐immunoreactive neurons co‐innervating motor endplates in the mouse esophagus

Zinsser-Krys

Kapitza

Böhnke

et al. 2022

The Anatomical Record

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Serotonin immunoreactivity was previously found in myenteric neurons coinnervating motor endplates in the mouse esophagus striated muscle and an involvement in motility control was suggested. However, it is not known if other neuroactive substances are present in these neurons and to what extent they co-localize. First, vasoactive intestinal peptide (VIP) was established as a bona fide marker for putative inhibitory myenteric neurons by evaluating colocalization with neuronal nitric oxide synthase (nNOS) and neuropeptide Y (NPY). Then, co-localization of serotonin and VIP was tested in co-innervating axons on motor endplates, which were visualized with α-bungarotoxin (α-BT) by multilabel immunofluorescence. Myenteric ganglia were also surveyed for co-localization in neuronal perikarya and varicosities. nNOS, NPY, and VIP were completely co-localized in enteric co-innervating nerve terminals on motor endplates. After co-staining with VIP, we found (a) serotonin (5-HT)positive nerve endings without VIP (44% of 5-HT-positively innervated endplates), (b) 5-HT-and VIP-positive endings without co-localization (35%), and (c) 5-HT-and VIP-positive endings with co-localization (21%). About one-fifth of nerve terminals on motor endplates containing 5-HT originate from putative inhibitory peptidegic nitrergic neurons. However, the majority represents a different population presumably subserving different functions.

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Influence of prucalopride on esophageal secondary peristalsis in reflux patients with ineffective motility

Cited by 38 publications

References 37 publications

Gastroesophageal reflux disease and chronic cough: A possible mechanism elucidated by ambulatory pH‐impedance‐pressure monitoring

Gastroesophageal reflux disease and chronic cough: A possible mechanism elucidated by ambulatory pH‐impedance‐pressure monitoring

Mosapride Improves Lower Esophageal Sphincter and Esophageal Body Function in Patients With Minor Disorders of Esophageal Peristalsis

Neurochemical classification of serotonin‐immunoreactive neurons co‐innervating motor endplates in the mouse esophagus

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