Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Apr 7, 2012; 18(13): 1517-1524
Published online Apr 7, 2012. doi: 10.3748/wjg.v18.i13.1517
Comparison of PPIs and H2-receptor antagonists plus prokinetics for dysmotility-like dyspepsia
Masahiro Sakaguchi, Miyuki Takao, Yasuo Ohyama, Hiroshi Oka, Hiroshi Yamashita, Takumi Fukuchi, Kiyoshi Ashida, Masahiro Murotani, Masuyo Murotani, Kazuo Majima, Hiroshi Morikawa, Takashi Hashimoto, Keisuke Kiyota, Hirohiko Esaki, Kanji Amemoto, Gouhei Isowa, Fumiyuki Takao
Masahiro Sakaguchi, Miyuki Takao, Yasuo Ohyama, Hiroshi Oka, Department of Gastroenterology, Moriguchi Keijinkai Hospital, Moriguchi, Osaka 570-0021, Japan
Hiroshi Yamashita, Takumi Fukuchi, Kiyoshi Ashida, Department of Gastroenterology, Osaka Saiseikai Nakatsu Hospital, Osaka 530-0012, Japan
Masahiro Murotani, Masuyo Murotani, Murotani Clinic, Kadoma, Osaka 571-0008, Japan
Kazuo Majima, Majima Clinic, Neyagawa, Osaka 572-0084, Japan
Hiroshi Morikawa, Morikawa Clinic, Hirakata, Osaka 573-0058, Japan
Takashi Hashimoto, Hashimoto Clinic, Moriguchi, Osaka 570-0079, Japan
Keisuke Kiyota, Kiyota Clinic, Matsubara, Osaka 580-0004, Japan
Hirohiko Esaki, Department of Gastroenterology, Arisawa General Hospital, Hirakata, Osaka 573-1195, Japan
Kanji Amemoto, Amemoto Clinic, Moriguchi, Osaka 570-0021, Japan
Gouhei Isowa, Isowa Clinic, Neyagawa, Osaka 572-0062, Japan
Fumiyuki Takao, Mii Clinic, Neyagawa, Osaka 572-0019, Japan
Author contributions: Sakaguchi M conducted the research and co-wrote the paper; Takao M contributed to the study design and data analysis, conducted the research and co-wrote the paper; Ashida K, Yamashita H, Fukuchi T, Ohyama Y, Oka H, Murotani M, Murotani M, Majima K, Morikawa H, Hashimoto T, Kiyota K, Esaki H, Amemoto K, Isowa G and Takao F conducted the research; Sakaguchi M contributed to the supervision of the study and overall control.
Correspondence to: Masahiro Sakaguchi, MD, Department of Gastroenterology, Moriguchi Keijinkai Hospital, 2-47-12, Yakumo Higashi-machi, Moriguchi-shi, Osaka 570-0021, Japan. kjsakaguchi@mkc.zaq.ne.jp
Telephone: +81-6-69069000 Fax: +81-6-69069008
Received: April 28, 2011
Revised: August 21, 2011
Accepted: January 22, 2012
Published online: April 7, 2012
Abstract

AIM: To compare efficacy of proton pump inhibitors (PPIs) with H2-receptor antagonists (H2RAs) plus prokinetics (Proks) for dysmotility-like symptoms in functional dyspepsia (FD).

METHODS: Subjects were randomized to receive open-label treatment with either rabeprazole 10 mg od (n = 57) or famotidine 10 mg bid plus mosapride 5 mg tid (n = 57) for 4 wk. The primary efficacy endpoint was change (%) from baseline in total dysmotility-like dyspepsia symptom score. The secondary efficacy endpoint was patient satisfaction with treatment.

RESULTS: The improvement in dysmotility-like dyspepsia symptom score on day 28 was significantly greater in the rabeprazole group (22.5% ± 29.2% of baseline) than the famotidine + mosapride group (53.2% ± 58.6% of baseline, P < 0.0001). The superior benefit of rabeprazole treatment after 28 d was consistent regardless of Helicobacter pylori status. Significantly more subjects in the rabeprazole group were satisfied or very satisfied with treatment on day 28 than in the famotidine + mosapride group (87.7% vs 59.6%, P = 0.0012). Rabeprazole therapy was the only significant predictor of treatment response (P < 0.0001), defined as a total symptom score improvement ≥ 50%.

CONCLUSION: PPI monotherapy improves dysmotility-like symptoms significantly better than H2RAs plus Proks, and should be the treatment of first choice for Japanese FD.

Keywords: Dysmotility; Functional dyspepsia; H2-receptor antagonist; Prokinetics; Proton pump inhibitor