Prokinetics for the treatment of functional dyspepsia: Bayesian network meta-analysis

Abstract

BackgroundControversies persist regarding the effect of prokinetics for the treatment of functional dyspepsia (FD). This study aimed to assess the comparative efficacy of prokinetic agents for the treatment of FD.MethodsRandomized controlled trials (RCTs) of prokinetics for the treatment of FD were identified from core databases. Symptom response rates were extracted and analyzed using odds ratios (ORs). A Bayesian network meta-analysis was performed using the Markov chain Monte Carlo method in WinBUGS and NetMetaXL.ResultsIn total, 25 RCTs, which included 4473 patients with FD who were treated with 6 different prokinetics or placebo, were identified and analyzed. Metoclopramide showed the best surface under the cumulative ranking curve (SUCRA) probability (92.5%), followed by trimebutine (74.5%) and mosapride (63.3%). However, the therapeutic efficacy of metoclopramide was not significantly different from that of trimebutine (OR:1.32, 95% credible interval: 0.27–6.06), mosapride (OR: 1.99, 95% credible interval: 0.87–4.72), or domperidone (OR: 2.04, 95% credible interval: 0.92–4.60). Metoclopramide showed better efficacy than itopride (OR: 2.79, 95% credible interval: 1.29–6.21) and acotiamide (OR: 3.07, 95% credible interval: 1.43–6.75). Domperidone (SUCRA probability 62.9%) showed better efficacy than itopride (OR: 1.37, 95% credible interval: 1.07–1.77) and acotiamide (OR: 1.51, 95% credible interval: 1.04–2.18).ConclusionsMetoclopramide, trimebutine, mosapride, and domperidone showed better efficacy for the treatment of FD than itopride or acotiamide. Considering the adverse events related to metoclopramide or domperidone, the short-term use of these agents or the alternative use of trimebutine or mosapride could be recommended for the symptomatic relief of FD.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-017-0639-0) contains supplementary material, which is available to authorized users.

Acotiamide affects antral motility, but has no effect on fundic motility, gastric emptying or symptom perception in healthy participants

“…Functional dyspepsia (FD) is a common functional gastrointestinal disorder with a major social and economic impact in patients . Based on symptom pattern, the Rome III and IV consensus subdivided FD into two distinct subgroups: the epigastric pain syndrome (EPS) and the postprandial distress syndrome (PDS).…”

“…Acid suppressants, such as proton pump inhibitors (PPIs) are often used as first‐line treatment, but have only modest efficacy which is most evident for EPS and less for PDS . Prokinetic agents on the other hand aim at improving impaired gastrointestinal motility, including gastric emptying and gastric accommodation, which is thought to underlie PDS symptoms . The availability of effective prokinetic agents is limited and their efficacy remains controversial .…”

“…Functional dyspepsia (FD) is a common functional gastrointestinal disorder with a major social and economic impact in patients. 1,2 Based on symptom pattern, the Rome III and IV consensus subdivided FD into two distinct subgroups: the epigastric pain syndrome (EPS) and the postprandial distress syndrome (PDS). EPS is characterized by meal-unrelated symptoms including epigastric pain and epigastric burning, whereas PDS is characterized by meal-induced symptoms such as postprandial fullness and early satiation.…”

“…2,9 Prokinetic agents on the other hand aim at improving impaired gastrointestinal motility, including gastric emptying and gastric accommodation, which is thought to underlie PDS symptoms. 2 The availability of effective prokinetic agents is limited and their efficacy remains controversial. 2,10,11 Second-line treatment often consists of antidepressant agents, based on the presence of visceral hypersensitivity as a pathophysiological mechanism and the high prevalence of psychosocial comorbidities such as anxiety and depression in refractory FD patients.…”

“…2 The availability of effective prokinetic agents is limited and their efficacy remains controversial. 2,10,11 Second-line treatment often consists of antidepressant agents, based on the presence of visceral hypersensitivity as a pathophysiological mechanism and the high prevalence of psychosocial comorbidities such as anxiety and depression in refractory FD patients. 12 Taken together, treatment options for FD are limited and the need for new effective, safe and cost-effective therapeutic options for the treatment of FD is high.…”