The Effect Of Itopride Combined With Esomeprazole In NERO Patients With Esophageal Motility Disorders

Background and Objective： Gastroesophageal reflux disease (GERD) is a commonchronic disease of upper gastrointestinal tract。The non-erosive gastroesophageal refluxdisease (NERD) is the largest proportion in GERD, accounting for about50%to70%andit causes serious influence to the quality of life. Acid inhibitors are main drugs in thetreatment of NERD, but the effect is not satisfactory. Esophageal motility disorders aremajor pathogenesis of NERD, so prokinetic agents should be effective on NERD, however,its efficacy is controversial. Itopride is a newly developed prokinetic agents. The aim of thisstudy is to examine the effect of itopride on NERD symptom, esophageal motility andesophageal acid exposure.Methods:30NERD patients with esophageal motility disorders and abnormal reflux (acid,weak acid or non-acid) were involve in this study. They were divided in three groupsrandomly. low-dose itopride group: itopride50mg thrice a day combind with esomeprazole20mg twice a day for4weeks; high-dose itopride group: itopride100mg thrice a daycombind with esomeprazole20mg twice a day for4weeks;、control group: esomeprazole20mg twice a day for4weeks. before and after4weeks treatment, GERDQ,high-resolution esophageal manometry and24hours esophageal pH monitoring wereperformed. Every patient was given10liquid swallows(5ml water) and10solidswallows(2*2cm bread).Result:1.After4-week treatment，the effective rate of the improved clinical symptomsof C,A,B is50%、54.55%、63.64%.，the clinical efficacy of groups combined with itoprideis better than esomeprazole using alone；2. The change of the esophageal motility(1)Groups combined with itopride have a higher improvement about the LES comparedwith the control group as150mg itopride(16.09±7.04vs20.21±7.16, P=0.027) and300mg itopride(15.46±2.59vs20.88±3.91, P=0.001), there is no obvious statistical significance between the150mg itopride group and300mg itopride group.(2)Groupscombined with itopride have a higher improvement about the distal contraction amplitudecompared with the control group as150mg itopride(54.60±24.01vs72.70±30.27,P=0.036) and300mg itopride (70.17±19.14vs76.76±19.30, P=0.042), while there is noobvious statistical significance between the two groups;(3) the change of the CFV doesn’thas clinical significance(P>0.05);(4)compared with the group of40mg esomeprazole,groups with itopride can not only reduce the total morbidity of both liquid andsolid swallows，but also increase swallowing success rate of the two bolus and theaverage of individual success rate of solid swallow swallowing (P <0.05), while there is noobvious statistical significance between the two.3. the change of esophageal24hours pHmonitoring:(1)Three groups can reduce the DeMeester scores and pH<4percent time, butthe comparison between groups and comparison by itself has no obvious meaning instatistics (P﹥0.05).（2）Compare to the control group,150mg itopride group and300mgitopride group both can decrease the percent of proximal acid, weak acid reflux times aslow-dose itopride group(acid：P=0.047，weak acid：P=0.016) and high-dose itopridegroup(acid：P=0.043，weak acid：P=0.072close to statistical significance)，only40mgesomeprazole(P﹥0.05)，but there is no obvious statistical significance between the twogroups combined with itopride.Conclusion: Contrast to the group of40mg esomeprazole, itopride combined withesomeprazole can more effectively relieve NERD symptoms, increase LES pressure anddistal contraction amplitude, but also decrease proximal esophageal reflux times in NERDpatients with esophageal motility disorders. But the clinical effect didn’t increase as thegrowing of the dose of itopride.