Therapeutic effect of Wendan Decoction combined with mosapride on gastroesophageal reflux disease after esophageal cancer surgery

BACKGROUND Gastroesophageal reflux disease(GERD)is a common complication of esophageal cancer surgery that can affect quality of life and increase the risk of esophageal stricture and anastomotic leakage.Wendan Decoction(WDD)is a traditional Chinese herbal formula used to treat various gastrointestinal disorders,such as gastritis,functional dyspepsia,and irritable bowel syndrome.Mosapride,a prokinetic agent,functions as a selective 5-hydroxytryptamine 4 agonist,enhancing gastrointestinal motility.AIM To evaluate the therapeutic effects of WDD combined with mosapride on GERD after esophageal cancer surgery.METHODS Eighty patients with GERD were randomly divided into treatment(receiving WDD combined with mosapride)and control(receiving mosapride alone)groups.The treatment was conducted from January 2021 to January 2023.The primary outcome was improved GERD symptoms as measured using the reflux disease questionnaire(RDQ).The secondary outcomes were improved esophageal motility(measured using esophageal manometry),gastric emptying(measured using gastric scintigraphy),and quality of life[measured via the Short Form-36(SF-36)Health Survey].RESULTS The treatment group showed a notably reduced RDQ score and improved esophageal motility parameters,such as lower esophageal sphincter pressure,peristaltic amplitude,and peristaltic velocity compared to the control group.The treatment group showed significantly higher gastric emptying rates and SF-36 scores(in both physical and mental domains)compared to the control group.No serious adverse effects were observed in either group.CONCLUSION WDD combined with mosapride is an effective and safe therapy for GERD after esophageal cancer surgery.It can improve GERD symptoms,esophageal motility,gastric emptying,and the quality of life of patients.Further studies with larger sample sizes and longer follow-up periods are required to confirm these findings.

Efficacy of mosapride citrate with polyethylene glycol solution for colonoscopy preparation

AIM:To evaluate the efficacy and safety of adjunctive mosapride citrate for bowel preparation before colonoscopy. METHODS:We conducted a randomized,double-blind, placebo-controlled study with mosapride in addition to polyethylene glycol(PEG)-electrolyte solution.Of 250 patients undergoing colonoscopy,124 were randomized to receive 2 L PEG plus 15 mg of mosapride citrate (mosapride group),and 126 received 2 L PEG plus placebo(placebo group).Patients completed a questionnaire reporting the acceptability and tolerability of the bowel preparation process.The efficacy of bowel preparation was assessed by colonoscopists using a 5-point scale based on Aronchick's criteria.The primary end point was optimal bowel preparation rates(scores of excellent/good/fair vs poor/inadequate). RESULTS:A total of 249 patients were included in the analysis.In the mosapride group,optimal bowel preparation rates were significantly higher in the left colon compared with the placebo group(78.2%vs 65.6%,P<0.05),but not in the right colon(76.5%vs 66.4%,P=0.08).After excluding patients with severe constipation,there was a significant difference in bowel preparation in both the left and right colon(82.4%vs 66.7%,80.8%vs 67.5%,P<0.05,P<0.01).The incidence of adverse events was similar in both groups. Among the subgroup who had previous colonoscopy experience,a significantly higher number of patients in the mosapride group felt that the current preparation was easier compared with patients in the placebo group(34/72 patients vs 24/74 patients,P<0.05). CONCLUSION:Mosapride citrate may be an effective and safe adjunct to PEG-electrolyte solution that leads to improved quality of bowel preparation,especially in patients without severe constipation.

Efficacy of mosapride plus proton pump inhibitors for treatment of gastroesophageal reflux disease: A systematic review

AIM:To assess the potential benefits of mosapride plus proton pump inhibitors(PPIs)in the treatment of gastroesophageal reflux disease.METHODS:A literature search was performed through MEDLINE,EMBASE,and the ISI Web of Knowledge.The clinical trials that compared the benefit of mosapride plus PPI treatment with that of PPI monotherapy were analyzed.The rate of responders was evaluated by the pooled relative risk(PRR)and improvement in symptom scores was assessed by single effect size of a standardized mean,while Hedges’g was used as the effect size.Pooled effect sizes with 95%CIs were calculated using a fixed-effects model.Between-study heterogeneity was assessed using Q test and I2analyses.In addition,studies that assessed the additional efficacy of mosapride in PPI-resistant patients were also reviewed.RESULTS:This systematic review included information on a total of 587 patients based on 7 trials.Four trials compared the efficacy of combination therapy of mosapride plus a PPI with that of PPI monotherapy.The statistical analysis for the effect of additional mosapride showed equivocal results(PRR=1.132;95%CI:0.934-1.372;P=0.205;Hedges’g=0.24;95%CI:0.03-0.46;P=0.023).No heterogeneity and publication bias were found among the studies.Three openlabeled trials assessed the additional efficacy of mosapride in PPI-resistant patients.However,since these trials did not set the control group,the results may be considerably biased.CONCLUSION:Mosapride combined therapy is not more effective than PPI alone as first-line therapy.Whether it is effective in PPI-resistant patients needs to be determined.

Can mosapride citrate reduce the volume of lavage solution for colonoscopy preparation?

AIM:To evaluate the possibility of reducing the volume of polyethylene glycol(PEG)-electrolyte solution using adjunctive mosapride citrate for colonoscopy preparation. METHODS:This was a single-center,prospective, randomized,investigator-blinded,non-inferiority study involving 252 patients of both sexes,aged from 20 to 80 years,scheduled for screening or diagnostic colonoscopy in our department.A total of 126 patients was randomized to receive 1.5 L PEG-electrolyte solution plus 15 mg of mosapride(1.5 L group),and 126 received 2 L PEG-electrolyte solution plus 15 mg of mosapride(2 L group).Patients completed a questionnaire on the acceptability and tolerability of the bowel preparation process.The efficacy of bowel preparation was assessed using a 5-point scale based on the Aronchick scale.The primary end point was adequate bowel preparation rates(score of excellent/good/fair) vs(poor/inadequate).Acceptability and tolerability,as well as disease detection,were secondary end points. RESULTS:A total of 244 patients was included in the analysis.There were no significant differences between the 2 L and 1.5 L groups in age,sex,body mass index, number of previous colonoscopies,and the preparation method used previously.The adequate bowel preparation rates were 88.5%in the 2 L group and 82.8%in the 1.5 L group[95%lower confidence limit(LCL)for the difference=-14.5%,non-inferiority P=0.019]in the right colon.In the left colon,the adequate bowel preparation rates were 89.3%in the 2 L group and 81.1%in the 1.5 L group(95%LCL=-17.0%,non-inferiority P=0.066).Compliance,defined as complete (100%)intake of the PEG solution,was significantly higher in the 1.5 L group than in the 2 L group(96.8% vs 85.7%,P=0.002).The proportion of abdominal distension(none/mild/moderate/severe)was significantly lower in the 1.5 L group than in the 2 L group (36/65/22/3 vs 58/48/18/2,P=0.040).Within the subgroup who had undergone colonoscopy previously, a significantly higher number of patients in the 1.5 L group than in the 2 L group felt that the current preparation was easier than the previous one(54.1%vs 28.0%,P=0.001).The disease detection rate was not significantly different between the two groups. CONCLUSION:Although the 1.5 L group had better acceptability and tolerability,15 mg of mosapride may be insufficient to compensate for a 0.5-L reduction of PEG solution.

Stability-indicating HPLC-DAD methods for determination of two binary mixtures:Rabeprazole sodium-mosapride citrate and rabeprazole sodium-itopride hydrochloride

Two selective stability-indicating HPLC methods are described for determination of rabeprazole sodium （RZ）-mosapride citrate （MR） and RZ-itopride hydrochloride （IO） mixturcs in the presence of their ICH-stress formed degradation products. Separations were achieved on X-Bridge CI 8 column using two mobile phases： the first for RZ-MR mixture consisted of acetonitrile： 0.（125 M KH,PO4 solution： TEA （30：69：1 v/v; pH 7.0）; the second for RZ-IO mixture was at ratio of 25：74：1 Iv/v： pH 9.25J. The detection wavelength was 283 nm. The two methods were validated and wdidation acceptance criteria were met in all cases. Peak purity testing using contrast angle theory, relative absorbance and log A versus the wavelengths plots were presented. The % recoveries of the intact drugs were between 99.1% and 102.2% with RSD% values less than 1.6%. Application of the proposed HPLC methods indicated that the methods could be adopted to follow the stability of their formulations.

胃肠动力药的发展及展望

胃肠道疾病是一类常见病及多发病,它的发病率约为60%。胃肠运动障碍是胃肠疾病的一个方面,由于它的发病原因至今还不是太清楚,因此给治疗带来一定的难度。它包括胃肠道收缩无力、节律紊乱和收缩方向异常等,临床症状有恶心、呕吐、上腹不适或疼痛、腹胀,严重如假性肠梗阻。随着胃肠道动力药甲氧氯普胺(胃复安)的出现,给胃肠运动障碍疾病的治疗带来了新的思维方式。本文就近年来胃肠动力药的发展状况及未来的发展趋势作一概述。

Bowel preparation prior to colonoscopy:A continual search for excellence

Bowel preparation prior to colonoscopy is essential to maximize the benefits of colonoscopy.Numerous bowel preparations have been studied,ranging from 4 L polyethylene glycol(PEG) to split-dose regimens to 2 L PEG with an adjunct laxative(senna,bisacodyl,ascorbic acid).Due to the large volume of PEG required for adequate bowel preparation,many studies have focused on reducing this large volume to only 2 L PEG with the addition of an adjunct.Recently,a randomized controlled trial by Tajika et al showed that the addition of mosapride to only 1.5 L PEG was non-inferior to mosapride and 2 L PEG for bowel cleansing but did provide improvements in patient tolerance.This study offers yet another potential bowel preparation for patients undergoing colonoscopy and may trigger further studies with 1.5 L PEG with an adjunct.In this letter,we discuss the current state of bowel preparation prior to colonoscopy and offer information to guide clinicians on choosing the appropriate bowel preparation for their patients.

Electrogastrography associated with symptomatic changes after prokinetic drug treatment for functional dyspepsia

AIM:To evaluate the effect of prokinetic drugs on electrogastrography(EGG) parameters according to symptomatic changes in patients with functional dyspepsia(FD).METHODS:Seventy-four patients with FD were prospectively enrolled in this study between December 2006 and December 2010.We surveyed the patients using a questionnaire on dyspeptic symptoms before and after an 8-wk course of prokinetic drug treatment.We also measured cutaneous pre-prandial and postprandial EGG recordings including percentage of gastric waves(normogastria,bradygastria,tachygastria),dominant frequency(DF),dominant power(DP),dominant frequency instability coefficient(DFIC),dominant power instability coefficient(DPIC),and the ratio of post-prandial to fasting in DP before and after the 8-wk course of prokinetic drug treatment.RESULTS:Fifty-two patients(70%) achieved symptomatic improvement after prokinetic drug treatment.Patients who had normal gastric slow waves showed symptom improvement group after treatment.Postprandial DF showed a downward trend in the symptom improvement group,especially in the itopride group.Post-prandial DP was increased regardless of symptom improvement,especially in the itopride group and mosapride group.Post-prandial DFIC and DPIC in the symptom improvement group were significantly increased after the treatment.The EGG power ratio was increased after treatment in the symptom improvement group(0.50 ± 0.70 vs 0.93 ± 1.77,P = 0.002),especially in the itopride and levosulpiride groups.CONCLUSION:Prokinetics could improve the symptoms of FD by regulating gastric myoelectrical activity,and EGG could be a useful tool in evaluating the effects of various prokinetics.

Eficacy of Electro-acupuncture in Treatment of Functional Constipation: A Randomized Controlled Trial

Functional constipation(FC)is a chronic discasc that significantly afcts the life quality of patients.Acupuncture has been used for the treatment of FC for many years,but its effectiveness has not been scientifcally assessed.The present study aimed to evaluate the efficacy of electro-acupuncture(EA)in relieving the symptoms,mental states and quality of life(QOL)of FC patients.A total of 96 FC patients were randomly allocated into EA,mosapride&sham EA group(MS)and mosapride control group(MC).In the EA group,patients were treated with 16 sessions of needling at Quchi(LI1I)and Shangjuxu(ST37)bilaterally,5 times a week in the first 2 weeks,and 3 times a.week in the last 2 weeks.In the MC group,patients were treated with 5 mg mosapride citrate three times a day for 4 weeks.In the MS group,patients underwent sham EA and the same mosapride citrate treatment as in the MC group.The primary outcome was the number of weekly spontaneous bowel movements(SBMs).The secondary outcomes included stool consistency,intensity of defecating difficulty,36-Item Short-Form Health Survey(SF-36),Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS),and the validated Patient Assessment of Constipation-Quality of Life(PAC-QOL).The results showed that as compared with the baseline,EA significantly improved the weekly SBMs,stool consistency and intensity of defecating difficulty(P<0.05).It also partly ameliorated the PAC-QOL,SF-36,SDS and SAS scores when compared with MC or MS group(P<0.05).However,no significant difference was observed between MS and MC groups in bowel function outcomes and QOL scores.It was concluded that EA could effectivcly improve bowel function,mental states and QOL of FC patients.

通腑调神针法治疗便秘型肠易激综合征:随机对照试验

Objective To observe the effects of bowls-unblocking and mind-regulating acupuncture therapy on constipation,anxiety,depression and serum neuropeptide Y(NPY)content for the patients with constipation-predominant irritable bowel syndrome(IBS-C).Methods Forty-two IBS-C patients were randomly assigned either into a bowls-unblocking and mind-regulating acupuncture group(acupuncture group)or a mosapride citrate group(medication group)with 21 cases in each group.During the treatment,one patient in the medication group was excluded and 20 patients were included in final statistical analysis;while 21 patients completed the trial in the acupuncture group.Before treatment,after treatment and in follow-up(1 month after the whole treatment),the scores of the Cleveland clinical constipation scoring system(CCS),the self-rating anxiety scale(SAS),and the self-rating depression scale(SDS)were assessed in both groups.The changes in NPY content were compared before and after treatment.Results①Total score of CCS:after treatment,the total score in the acupuncture group and the medication group were(4.76±2.10)points and(5.60±1.88)points,respectively,which were significantly lower than those before treatment in both groups(both P<0.05);and the difference in the score was not significant for the between-group comparison(P>0.05).In the follow-up,the total scores were(4.19±1.69)points in the acupuncture group,and was(6.35±2.06)points in the medication group.The score in the medication group was higher than that after treatment in the same group(P<0.05),but there was no significant difference between acupuncture group and the medication group(P>0.05).②SAS score:after treatment,the SAS scores were(50.24±2.19)points and(53.45±2.46)points in the acupuncture group and the medication group,respectively,which was lower than that before treatment in the two groups(both P<0.05);and the difference in the score was significant between two groups(P<0.05).In the follow-up,the scores were(51.95±2.27)points and(54.55±1.67)points in the acupuncture group and the medication group,respectively;which was lower than that before treatment in the two groups(both P<0.05),and the difference in the score was significant between two groups(P<0.05).③SDS score:after treatment,the SDS scores were(50.71±2.70)points and(53.15±2.25)points in the acupuncture group and the medication group,respectively,which was significantly lower than that before treatment in the two groups(both P<0.05);and the difference in the score was significant between the two group(P<0.05).In the follow-up,the score of the acupuncture group was(52.57±3.72)points and it was(56.60±2.42)points in the medication group,which was significantly lower than that before treatment in the two groups(both P<0.05);and the difference in the score was significant between the two groups(P<0.05).④Comparison of serum NPY content:after treatment,the serum NPY content of the acupuncture group and the medication group were(7.08±3.02)mmol/L and(9.89±3.82)mmol/L,respectively,which was significantly lower than that before treatment within each group(both P<0.05).The difference was significant between the two groups(P<0.05).⑤Effective rate:after treatment,the total effective rate was 95.24%in the acupuncture group and 90.00%in the medication group,without statistically significant difference(P>0.05).Conclusions bowls-unblocking and mind-regulating acupuncture therapy relieved the defecation-related symptoms,anxiety,and depression in IBS-C patients;and it was more effective on abdominal pain compared with mosapride citrate.Acupuncture therapy also had some long-term effect,which may be related to its regulatory effect on the serum NPY content.