Effect of itopride, a new prokinetic, in patients with mild GERD: A pilot study

AIM: Itopride is a newly developed prokinetic agent, which enhances gastric motility through both antidopaminergic and anti-acetylcholinesterasic actions. The importance of esophageal motor dysfunction in the pathogenesis of gastro-esophageal reflux disease (GERD) makes it interesting to examine the effect of itopride on esophageal acid exposure.METHODS: The effect of itopride on esophageal acid reflux variables for 24 h was studied in 26 patients with GERD symptoms, pre-entry total acid exposure time (pH＜4) of more than 5% and mild esophagitis (SavaryMiller grades Ⅰ, Ⅱ) proven by endoscopy. Ambulatory 24-h pH-metry and symptom assessment were performed after treatments with 150 or 300 mg itopride thrice a day (t.i.d.) for 30 d in random order, using an open label method.For evaluating the safety of itopride, blood biochemical laboratory test was performed and the serum prolactin level was also examined before and after treatment.RESULTS: Total symptom score was significantly decreased after treatment in 150- or 300-mg group. Itopride 300mg was significantly effective than 150 mg on decreasing the total per cent time with pH＜4, total time with pH＜4and DeMeester score. No serious adverse effects were observed with administration of itopride in both groups.CONCLUSION: Itopride 100 mg t.i.d, is effective on decreasing pathologic reflux in patient with GERD and therefore it has the potential to be effective in the treatment of this disease.

Preoperative colonoscopy through the colonic stent in patients with colorectal cancer obstruction

AIM:To evaluate the feasibility of a preoperative colonoscopy through a self-expendable metallic stent(SEMS)and to identify the factors that affect complete colonoscopy.METHODS:A total of 48 patients who had SEMS placement because of acute malignant colonic obstruction underwent preoperative colonoscopy.After effective SEMS placement,patients who showed complete resolution of radiological findings and clinical signs of acute colon obstruction underwent a standard bowel preparation.Preoperative colonoscopy was then performed using a standard colonoscope.If the passage of colonoscope was not feasible gastroscope was used.After colonoscopy,cecal intubation time,grade of bowel preparation,tumor location,stent location,presence of synchronous polyps or cancer,damage to colonoscopy and bleeding,and stent migration after colonoscopy were recorded.RESULTS:Complete evaluation with colonoscope was possible in 30 patients(62.5%).In this group,adenoma was detected in 13 patients(43.3%).The factors that affected complete colonoscopy were also analyzed:Tumor location at an angle;stent placement at an angle;and stent expansion diameter,which affected complete colonoscopy significantly.However in multivariate analysis,stent expansion diameter was the only significant factor that affected complete colonoscopy.Complete evaluation using additional gastroscope was feasible in 42 patients(87.5%).CONCLUSION:Preoperative colonoscopy through the colonic stent using only conventional colonoscope was unfavorable.The narrow expansion diameter of the stent may predict unfavorable outcome.In such a case,using small caliber scope should be considered and may expect successful outcome.

DA-9601 for erosive gastritis:Results of a double-blind placebo-controlled phase Ⅲ clinical trial

AIM: To determine the efficacy and safety of DA-9601 on erosive gastritis versus cetraxate as a standard drug by gastrointestinal endoscopy.METHODS: Five hundred and twelve patients with erosive gastritis were divided into three groups. The groups received 180 mg or 360 mg of DA-9601, or 600 mg of cetraxate (Neuer^TM) t.i.d, for 2 wk, respectively. Endoscopic observations were performed before and 2 wk after the treatment, and the cure and improvement rates were investigated.RESULTS: Of the 512 intention-to-treat (ITT) population,457 patients comprised the per protocol (PP) analysis.Endoscopic cure rate was significantly higher in the DA-9601 group than in the cetraxate group in both the PP (56%, 58% vs 36% DA-9601 180 mg, 360 mg and cetraxate,respectively) and ITT (52%, 51% vs 35%) populations.Two DA-9602 groups (280 and 360 mg) had significantly higher endoscopic improvement rates than the cetraxate group in both the PP (67%, 65% vs 46%) and In (63%,58% vs 45%) populations. The percentage of symptom relief over the 2 wk was found not significantly different between groups. During the study, both DA-9602 and cetraxate produced no treatment-associated adverse events.CONCLUSION: From these results, it appears that DA-9601 has excellent efficacy on erosive gastritis. This study also confirms the safety profile of DA-9601.