Acotiamide Has No Effects on Esophageal Motor Activity or Esophagogastric Junction Compliance

Abstract

Background/aims: The novel prokinetic drug acotiamide is used for treatment of functional dyspepsia. It is still unclear how acotiamide has effects on esophageal motor function. Esophageal peristalsis and esophagogastric junction (EGJ) compliance has an important role for prevention of esophageal mucosal damage caused by gastroesophageal reflux, however, few studies have analyzed the effects of acotiamide on those former activities and none have investigated its effects on EGJ compliance. The aim of our research was to examine the effects of acotiamide on esophageal motility and EGJ compliance.

Methods: We enrolled 3 gastroesophageal reflux disease (GERD) patients as well as 9 healthy volunteers. Using high-resolution manometry, we examined esophageal motor activity parameters, including esophageal body contractions and lower esophageal sphincter (LES) pressure. While, EGJ compliance was evaluated using a functional lumen imaging probe. Following determination of baseline values for esophageal motor activities and EGJ compliance, acotiamide at a standard dose of 300 mg/day was administered for 3 days. All measurements were performed again 2 hours after the last acotiamide administration.

Results: In the healthy volunteers, as compared with the baseline values, acotiamide administration did not significantly change esophageal body contractions and LES pressure. And EGJ distensibility was not significantly changed (distensibility index in 40-mL distension: 3.5 ± 0.4 vs 3.3 ± 0.5 mm²/mmHg). Similarly in the GERD patients, there were no differences in either esophageal motility or EGJ compliance between before and after acotiamide administration (distensibility index in 40-mL distension: 6.2 ± 0.5 vs 6.5 ± 1.1 mm²/mmHg).

Conclusion: In both healthy individuals and GERD patients, standard dose acotiamide dose does not have significant effects on esophageal motor activities or EGJ compliance.

Keywords: Acotiamide; Esophageal motility; Esophagogastric junction; Gastroesophageal reflux disease; Manometry.

Figure

Esophagogastric junction (EGJ) compliance with and without acotiamide. (A) An endo-luminal functional lumen imaging probe (EndoFLIP) system was used to monitor EGJ compliance at baseline and following acotiamide administration. Using the special solution provided, the bag included with the system was distended by 20, 30, and 40 mL by which its shape changed to an hourglass form corresponding to distention volume with both acotiamide administration and at the baseline. There were no differences in bag shape following acotiamide administration. (B) Baseline and acotiamide administration values presented as distensibility index graph. To evaluate distensibility index, intra-bag pressure (x-axis) and hiatal cross-sectional area (CSA) (y-axis) values were determined with the EndoFLIP bag distended to 20 mL (circles), 30 mL (squares), and 40 mL (triangles). There were no significant differences between results obtained at baseline and those with acotiamide administration.