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

Abstract

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.

The Need for Updated Classification of Esophageal Motility Disorders Using High-resolution Impedance Manometry

“… 8 , 10 , 11 A recent meta-analysis study including 16 randomized control trials reported that PPIs with prokinetics showed a significant reduction in global GERD symptoms regardless of the prokinetic type, refractoriness, or ethnicity compared to PPI monotherapy (risk ratio of reflux symptoms resolution, 1.22; 95% confidence interval, 1.11 to 1.35; P < 0.0001). 12 Mosapride improved esophageal symptoms and significantly enhanced distal contractile integral in a study by Kim et al 13 The medical approach should be determined by the patient’s symptoms. However, it seems that medication may be considered if symptoms are present.…”