J Neurogastroenterol Motil  https://doi.org/10.5056/jnm20190
Efficacy of acotiamide on postprandial distress syndrome and epigastric pain syndrome depending on the estimated gastric acid secretion level
Toshiaki Suzuki,1 Reina Ohba,1 Ei Kataoka,2 Yui Kudo,3 Akira Zeniya,4 Daisuke Segawa,5 Keisuke Oikawa,6 Masaru Odashima,7 Taiji Saga,8 Tomoyuki Kuramitsu,9 Hideaki Sasahara,10 Kazuo Yoneyama,11 Takashi Tomita,12 Yosuke Shimodaira,1 and Katsunori Iijima1*
1Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan; 2Kataoka Internal Medicine Clinic, Akita, Japan; 3Kudo Gastroenterology Clinic, Akita, Japan; 4Zeniya Clinic, Akita, Japan; 5Segawa Clinic, Noshiro, Japan; 6Oikawa Clinic, Akita, Japan; 7Odashima Masaru Clinic, Yokote, Japan; 8Matsugasaki Clinic, Akita, Japan; 9Kuramitsu Clinic, Akita, Japan; 10Sasahara Internal Medicine Clinic, Akita, Japan; 11Yoneyama Gastroenterology Clinic, Akita, Japan; and 12Tomita Gastroenterology Clinic, Akita, Japan
Correspondence to: Katsunori Iijima, MD, PhD
Department of Gastroenterology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Akita, Japan
Tel: +81-18-884-6573, Fax: +81-18-801-7501, E-mail: kiijima@med.akita-u.ac.jp
Received: August 21, 2020; Revised: October 14, 2020; Accepted: October 24, 2020; Published online: August 6, 2021
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

Abstract
Background/Aims
Gastric acid secretion is suspected to be a pivotal contributor to the pathogenesis of functional dyspepsia. The present study investigates the potential association of the gastric acid secretion estimated by measuring serum pepsinogen with therapeutic responsiveness to the prokinetic drug acotiamide.
Methods
Dyspeptic patients consulting participating clinics from October 2017 to March 2019 were prospectively enrolled in the study. The dyspeptic symptoms were classified into postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). Gastric acid secretion levels were estimated by the Helicobacter pylori infection status and serum pepsinogen using established criteria and classified into hypo-, normo-, and hyper-secretion. Each patient was then administered 100 mg acotiamide thrice daily for 4 weeks, and the response rate to the treatment was evaluated using the overall treatment efficacy scale.
Results
Of the 86 enrolled patients, 56 (65.1%) and 26 (30.2%) were classified into PDS and EPS, respectively. The estimated gastric acid secretion was not significantly different between PDS and EPS. The response rates were 66.0% for PDS and 73.1% for EPS, showing no significant difference. While the response rates were stable, ranging from 61.0% to 75.0% regardless of the estimated gastric acid secretion level among PDS subjects, the rates were significantly lower in hyper-secretors than in non-hyper-secretors among EPS subjects (42.0% vs 83.0%, P = 0.046).
Conclusion
Although acotiamide is effective for treating EPS as well as PDS overall, the efficacy is somewhat limited in EPS with gastric acid hyper-secretion, with gastric acid suppressants, such as proton pump inhibitors, being more suitable.
Keywords: Acotiamide; Epigastric pain syndrome; Gastric acid secretion; Serum pepsinogen; Postprandial distress syndrome


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