Proton pump inhibitor versus prokinetic therapy in patients with functional dyspepsia: is therapeutic response predicted by Rome III subgroups?

Hsu, Yao Chun; Liou, Jyh–Ming; Yang, Tzeng Huey; Hsu, Wei Lun; Lin, Hwai Jeng; Wu, Huei Tang; Lin, Jaw Town; Wang, Hsiu Po; Wu, Ming Shiang

doi:10.1007/s00535-010-0334-1

Cited by 39 publications

(42 citation statements)

References 41 publications

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“…Subgroup analysis suggests that those patients who have more prominent heartburn-related symptoms respond better to PPI therapy ( 119 ) but there is no evidence that epigastric pain syndrome responds better than postprandial distress syndrome type dyspepsia ( 115 ). We therefore do not recommend using the type of symptom in FD to guide treatment choice.…”

Section: Strong Recommendation Moderate Quality Evidencementioning

confidence: 99%

ACG and CAG Clinical Guideline: Management of Dyspepsia

Martin

Lacy

Andrews

et al. 2017

American Journal of Gastroenterology

510

520

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Section: Strong Recommendation Moderate Quality Evidencementioning

confidence: 99%

ACG and CAG Clinical Guideline: Management of Dyspepsia

Martin

Lacy

Andrews

et al. 2017

American Journal of Gastroenterology

510

520

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“…These results are compatible with a previous study. Hsu et al 8 reported similar symptom improvement (~50%) with 30-mg lansoprazole and mosapride in 329 patients with FD.…”

Section: Discussionmentioning

confidence: 84%

“…22 There are few studies directly comparing the efficacy of PPIs and prokinetics in Asia. Hsu et al 8 reported that the efficacy of PPI was similar to prokinetics in patients with FD according to the Rome III criteria after 2 weeks of treatment. In another study of 23 The co-administration of PPI and prokinetics is commonly prescribed for patients with FD and is frequently recommended by clinical guidelines, although the efficacy has been questioned.…”

Section: Discussionmentioning

confidence: 99%

“…7 In a recent open-label, randomized controlled trial with prokinetics compared to PPI in Asia, significant symptom relief was achieved in 50.6% of the PPI group and 47.9% of the prokinetics groups, and therapeutic responses between the 2 groups were not different. 8 DA-9701 (Motilitone) is a newly formulated prokinetic agent obtained from vegetal extracts of Pharbitidis semen and Corydalis tuber, used as traditional treatments for their analgesic and antiulcer effects. 9 In animal studies, DA-9701 improved the symptoms of FD by accelerating gastric emptying, promoting gastric accommodation, and modulation of visceral hypersensitivity through the antagonistic action at 5-hydroxytryptamine (HT) 3 or dopamine (D) 2 receptors, or agonistic action at the 5-HT 4 receptor.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of DA-9701 (Motilitone) in Functional Dyspepsia Compared to Pantoprazole: A Multicenter, Randomized, Double-blind, Non-inferiority Study

Jung

Lee

Choi

et al. 2016

J Neurogastroenterol Motil

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Background/AimsThe effect of proton pump inhibitors (PPI) in Asian functional dyspepsia (FD) patients has not been well established as in Western countries. DA-9701, a novel prokinetic agent, stimulates gastric emptying and modulates visceral hypersensitivity in vivo and in human studies. This study was conducted to compare the efficacy of DA-9701 with a conventional PPI in mono or combination therapy in patients with FD. MethodsIn this double-blind, randomized, non-inferiority trial, 389 patients diagnosed with FD using Rome III criteria were allocated among 3 groups: 30-mg DA-9701 t.i.d (means 3 times a day), 40-mg pantoprazole, and 30-mg DA-9701 t.i.d + 40-mg pantoprazole. The primary efficacy end-point was a global assessment of the patient binary response or response on a 5-Likert scale after 4 weeks. ResultsThe global symptomatic improvement was 60.5% in the DA-9701 group, 65.6% in the pantoprazole group, and 63.5% in the DA-9701 + pantoprazole group using a 5-Likert scale at week 4 with no significant difference among 3 groups (P = 0.685). Symptom improvement measured by binary outcome was significantly achieved in each of the 3 groups, but not different among groups. Patients in all treatment groups reported significant improvement in the response rate and symptoms according to FD subtypes and dyspepsia-related quality of life (P < 0.001), but there were no significant differences among the 3 groups.

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“…Proton-pump inhibitors (PPI) and prokinetic agents are the mainstays of the treatment of FD [39], both of which have similar relative efficacy [42]. However, adverse events related to PPI have been reported, and the comparative efficacy of prokinetics has thus far not been evaluated [43, 44].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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Proton pump inhibitor versus prokinetic therapy in patients with functional dyspepsia: is therapeutic response predicted by Rome III subgroups?

Abstract: The effectiveness of proton pump inhibitor therapy and that of prokinetic therapy in functional dyspepsia are not different, and cannot be predicted by Rome III subgroups (ClinicalTrials.gov number, NCT00663897).

Cited by 39 publications

References 41 publications

ACG and CAG Clinical Guideline: Management of Dyspepsia

ACG and CAG Clinical Guideline: Management of Dyspepsia

Efficacy of DA-9701 (Motilitone) in Functional Dyspepsia Compared to Pantoprazole: A Multicenter, Randomized, Double-blind, Non-inferiority Study

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

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