Timing and Predictors of Recurrence of Dyspepsia Symptoms after Cessation of Acotiamide Therapy for Functional Dyspepsia: A Long-Term Observational Study

Abstract

Background/Aims: The long-term outcomes of patients after cessation of acotiamide therapy in patients with functional dyspepsia remains unclear. The aim of this study is to investigate the timing and predictors of recurrence of dyspepsia symptoms after cessation of acotiamide therapy for functional dyspepsia. Methods: Seventy patients treated with acotiamide for functional dyspepsia who then ceased treatment were enrolled. Changes in dyspepsia symptoms were evaluated using the Izumo scale, a self-reporting questionnaire of abdominal symptom-related quality of life. Patients were subclassified into epigastric pain, postprandial distress, and overlapped types. Results: The mean follow-up after cessation of acotiamide was 1.9 years. After cessation of acotiamide, 39 patients (56%) had recurrence. Kaplan-Meier analysis revealed a recurrence-free rate of 51% at 1 year. Predictors of recurrence evaluated with a Cox proportional hazards model showed that overlapped-type dyspepsia and consultation with the treating physician before cessation were identified as significant positive and negative predictors, respectively (p < 0.05). The resumption of acotiamide significantly decreased the score for dyspepsia symptoms at 1 month. Conclusions: Dyspepsia symptoms recur about one year after cessation of acotiamide therapy. Patients with overlapped-type dyspepsia should be carefully followed after cessation. Patients should consult their treating physician before stopping acotiamide.

Yeokwisan, a Standardized Herbal Formula, Enhances Gastric Emptying via Modulation of the Ghrelin Pathway in a Loperamide-induced Functional Dyspepsia Mouse Model

“…Due to the clinical limitations of currently available drugs for FD including the relatively high recurrence rate after cessation of 51% ( Shinozaki et al, 2020 ), herbal resources have received attention in drug development ( Tan et al, 2020 ). We herein proved the anti-FD activity of Yeokwisan, a standardized formula consisting of a six-herbal mixture including P. trifoliata , S. baicalensis, G. uralensis, Massa medicata fermentata , P. bambusoides, O. gigas ( Table 1 ).…”

“…Based on these etiological factors, prokinetic drugs, such as ghrelin receptor agonists, serotonin (5-hydroxytryptamine, 5-HT) receptor agonists, muscarinic receptor antagonists, proton pump inhibitors (PPIs), and H. pylori eradicating drugs are used to treat patients with FD ( Ford et al, 2020 ). However, these treatments have clinical limitations, such as a high recurrence rate after cessation-, for example, the recurrence rate after cessation of acotiamide, a prokinetic, therapy, is a half ( Shinozaki et al, 2020 ), and unexpected adverse effects, such as an increased risk of myocardial infraction and risk of ventricular arrhythmias after long-term use of PPIs or cisapride (a 5-HT receptor agonist) ( De Maeyer et al, 2008 ; Shah et al, 2015 ).…”

Vonoprazan Therapy is as Effective for Functional Dyspepsia without Heartburn as Acotiamide Therapy

“…Significant symptoms were defined as 4 points or more for a specific score. The functional dyspepsia score was defined as the sum of the epigastric pain and postprandial distress domains [12]. The total score was defined as the sum of the scores for all domains.…”

The effectiveness of acupoint herbal patching for functional dyspepsia

“…Because of the multifactorial nature and heterogeneity of symptoms in FD, most of existing therapies have limitations and modest effectiveness [4] . Although acotiamide has been proven to improve gastric accommodation or emptying, symptoms of FD will recur about 1 year after cessation of acotiamide therapy [7] . Proton pump inhibitors are the most commonly used drugs of FD, but drug abuse and adverse events have gradually increased in recent years [8] .…”

“…[4] Although acotiamide has been proven to improve gastric accommodation or emptying, symptoms of FD will recur about 1 year after cessation of acotiamide therapy. [7] Proton pump inhibitors are the most commonly used drugs of FD, but drug abuse and adverse events have gradually increased in recent years. [8] Although imipramine as a tricyclic antidepressant can treat refractory FD, these side effects of dry mouth, constipation, drowsiness, insomnia, palpitations are worth considering.…”