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

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.

Effective administration method of intravenous proton pump inhibitor: a novel testing using a BRAVO catheterless pH monitoring system.

BACKGROUND/AIMS: This study investigated the use of the BRAVO catheterless pH monitoring system to determine the effective administration method of intravenous proton pump inhibitor and the effectiveness of 80 mg pantoprazole per day on the regulation of gastric acid. METHODS: A total of 32 patients who underwent endoscopic resection were randomly assigned to the repeated bolus injections group (40 mg dose, twice per day) and continuous infusion group (mixed with 5% glucose, continuous infusion of 80 mg per day). Then, pantoprazole was administered and intragastric pH was measured for 48 hours through a BRAVO capsule. The length of time until the intragastric pH reached 4 and 6 after administration was measured, as well as the mean/median pH for 48 hours and the fraction times (%) of pH >4 and >6 for 48 hours. The factors affecting intragastric pH were also analyzed. RESULTS: There were no complications due to the attachment of the BRAVO capsule. No significant differences according to administration methods were found in all factors. Only Helicobacter pylori had significant effect on the fraction times (%) of pH >4 and >6 for 48 hours (p<0.05). CONCLUSIONS: The effects of intravenous proton pump inhibitor were similar between the administration methods. Therefore, the repeated bolus injection method, which is relatively simple, is a good choice. Regarding the dose of intravenous pantoprazole, which is used after successful endoscopic hemostasis, 80 mg would be sufficient. We hope that this study encourages the use of the BRAVO catheterless pH monitoring system.

Normal 24-hour Ambulatory Esophageal pH Values in Koreans.

BACKGROUND/AIMS: Twenty-four-hour ambulatory esophageal pH monitoring is considered the gold standard for diagnosing gastroesophageal reflux disease. The aim of this study was to quantify normal distal esophageal acid parameters in healthy Koreans. METHODS: Thirty healthy adults who were not on medication and were free from gastrointestinal symptoms were analyzed. Ambulatory esophageal acid (pH <4) exposure parameters were recorded at 5 cm above the lower esophageal sphincter. RESULTS: The 95th percentiles for reflux parameters assessed in the distal esophagus were as follows: percentage of total time with pH <4, 5.10%; percentage of upright time with pH <4, 7.88%; percentage of supine time with pH <4, 4.00%; number of reflux episodes, 62.7; number of reflux episodes with pH <4 for >5 minutes, 5.3; and the longest single acid-exposure episode, 21.3 minutes. CONCLUSIONS: Physiological gastroesophageal reflux occurs frequently in healthy Koreans. These data provide a reference range that could be utilized in studies involving Korean subjects.