Effective Combination Therapy with Nizatidine and Acotiamide for Functional Dyspepsia

Yusaku Kajihara(1),


(1) Department of Gastroenterology, Fuyoukai Murakami Hospital, Japan
Corresponding Author

Abstract


Background: The two subgroups of Functional Dyspepsia (FD), including Postprandial Distress Syndrome (PDS) and Epigastric Pain Syndrome (EPS), can overlap. PDS–EPS overlap tends to reduce patients’ quality of life. Combination therapy with nizatidine and acotiamide may improve the symptoms of FD, including PDS–EPS overlap. A previous study reported the combined effect of rabeprazole and acotiamide. This study aimed to evaluate nizatidine as an alternative to rabeprazole.

Methods: This single-center retrospective study analyzed 66 patients with FD, including 45 and 21 patients receiving nizatidine/acotiamide and rabeprazole/acotiamide therapies, respectively. The regimen comprised nizatidine 150 mg twice daily, rabeprazole 10 mg once daily, and acotiamide 100 mg thrice daily. No prokinetics other than acotiamide (e.g., rikkunshito and mosapride) were simultaneously administered. The following characteristics were investigated: age, sex, diabetes mellitus, Parkinson’s disease, mental illness, subgroups of FD (PDS, EPS, or PDS–EPS overlap), and treatment-emergent adverse events. Symptom improvement rates following treatment were calculated and compared.

Results: Although differences in the FD subgroups were significant in terms of patients’ backgrounds, no significant difference in PDS–EPS overlap rates was observed (55.6% [25/45] vs. 61.9% [13/21], p = 0.79). The difference in symptom improvement rates between nizatidine/acotiamide and rabeprazole/acotiamide therapies was not significant (86.7% [39/45] vs. 85.7% [18/21], p = 1).

Conclusion: Nizatidine/acotiamide therapy demonstrated efficacy comparable to rabeprazole/acotiamide therapy in treating FD. Patients with FD frequently experience treatment difficulties owing to various underlying factors; however, nizatidine/acotiamide therapy with a high symptom improvement rate is a promising therapeutic option in refractory FD.

Keywords: Dyspepsia, nizatidine, rabeprazole


Keywords


Dyspepsia, nizatidine, rabeprazole

References


Matsuzaki J, Suzuki H, Asakura K, Fukushima Y, Inadomi JM, Takebayashi T, et al. Classification of functional dyspepsia based on concomitant bowel symptoms. Neurogastroenterol Motil 2012;24:325-e164.

Aziz I, Palsson OS, Törnblom H, Sperber AD, Whitehead WE, Simrén M. Epidemiology, clinical characteristics, and associations for symptom-based Rome Ⅳ functional dyspepsia in adults in the USA, Canada, and the UK: a cross-sectional population-based study. Lancet Gastroenterol Hepatol 2018;3:252-62.

Miwa H, Nagahara A, Asakawa A, Arai M, Oshima T, Kasugai K, et al. Evidence-based clinical practice guidelines for functional dyspepsia 2021. J Gastroenterol 2022;57:47-61.

Nowlan ML, Scott LJ. Acotiamide: first global approval. Drugs 2013;73:1377-83.

Harasawa S. Acinon® and acofide®. Med Pract 2014;31:1296-8 (in Japanese).

Yamawaki H, Futagami S, Kawagoe T, Maruki Y, Hashimoto S, Nagoya H, et al. Improvement of meal-related symptoms and epigastric pain in patients with functional dyspepsia treated with acotiamide was associated with acylated ghrelin levels in Japan. Neurogastroenterol Motil 2016;28:1037-47.

Kinoshita Y, Chiba T; FUTURE Study Group. Characteristics of Japanese patients with chronic gastritis and comparison with functional dyspepsia defined by ROME Ⅲ criteria: based on the large-scale survey, FUTURE study. Intern Med 2011;50:2269-76.

Manabe N, Haruma K, Hata J, Imamura H, Kamada T, Kusunoki H, et al. Clinical characteristics of Japanese dyspeptic patients: is the Rome Ⅲ classification applicable? Scand J Gastroenterol 2010;45:567-72.

Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant 2013;48:452-8.

Hojo M, Nagahara A, Asaoka D, Takeda T, Izumi K, Matsumoto K, et al. A randomized, double-blind, pilot study of the effect of famotidine on acotiamide treatment for functional dyspepsia. Digestion 2017;96:5-12.

Ueki S, Seiki M, Yoneta T, Aita H, Chaki K, Hori Y, et al. Gastroprokinetic activity of nizatidine, a new H2-receptor antagonist, and its possible mechanism of action in dogs and rats. J Pharmacol Exp Ther 1993;264:152-7.

Ohira Y, Hanyu N, Aoki T, Hashimoto Y, Iikura M, Fukuda S. Effects of various histamine H2-receptor antagonists on gastrointestinal motility and gastric emptying. J Smooth Muscle Res 1993;29:131-42 (in Japanese).

Kaneko H, Mitsuma T, Uchida K, Nagai H, Harada M, Kotera H. Nizatidine accelerates gastric emptying of a solid meal in rats. Dig Dis Sci 1995;40:2043-51.

Ueki S, Matsunaga Y, Yoneta T, Tamaki H, Itoh Z. Gastroprokinetic activity of nizatidine during the digestive state in the dog and rat. Arzneimittelforschung 1999;49:618-25.

Anjiki H, Sanaka M, Kuyama Y. Dual effects of rabeprazole on solid-phase gastric emptying assessed by the 13C-octanoate breath test. Digestion 2005;72:189-94.

Takahashi Y, Amano Y, Yuki T, Ose T, Miyake T, Kushiyama Y, et al. Influence of acid suppressants on gastric emptying: cross-over analysis in healthy volunteers. J Gastroenterol Hepatol 2006;21:1664-8.

Sanaka M, Anjiki H, Yamamoto T, Kuyama Y. Rabeprazole delays gastric emptying of a nutrient liquid. J Gastroenterol Hepatol 2007;22:1806-9.

Yamamoto T, Sanaka M, Anjiki H, Hattori K, Ishii T, Kuyama Y. No relationship between plasma desacyl-ghrelin levels and rabeprazole-related delay in gastric emptying: controlled study in healthy volunteers. Drugs R D 2008;9:345-8.

Terai S, Iijima K, Asanuma K, Ara N, Uno K, Abe Y, et al. Lack of modulation of gastric emptying by dietary nitrate in healthy volunteers. Tohoku J Exp Med 2009;218:73-9.

Miwa H, Nakajima K, Yamaguchi K, Fujimoto K, Veldhuyzen VAN Zanten SJ, et al. Generation of dyspeptic symptoms by direct acid infusion into the stomach of healthy Japanese subjects. Aliment Pharmacol Ther 2007;26:257-64.

Oshima T, Okugawa T, Tomita T, Sakurai J, Toyoshima F, Watari J, et al. Generation of dyspeptic symptoms by direct acid and water infusion into the stomachs of functional dyspepsia patients and healthy subjects. Aliment Pharmacol Ther 2012;35:175-82.

Ford AC, Moayyedi P, Black CJ, Yuan Y, Veettil SK, Mahadeva S, et al. Systematic review and network meta-analysis: efficacy of drugs for functional dyspepsia. Aliment Pharmacol Ther 2021;53:8-21.

Futagami S, Shimpuku M, Song JM, Kodaka Y, Yamawaki H, Nagoya H, et al. Nizatidine improves clinical symptoms and gastric emptying in patients with functional dyspepsia accompanied by impaired gastric emptying. Digestion 2012;86:114-21.

Quartero AO, de Wit NJ, Lodder AC, Numans ME, Smout AJ, Hoes AW. Disturbed solid-phase gastric emptying in functional dyspepsia: a meta-analysis. Dig Dis Sci 1998;43:2028-33.

Ochi M, Tominaga K, Tanaka F, Tanigawa T, Yamagami H, Watanabe K, et al. Clinical classification of subgroups according to the Rome Ⅲ criteria cannot be used to distinguish the associated respective pathophysiology in Japanese patients with functional dyspepsia. Intern Med 2013;52:1289-93.


Full Text: PDF

Article Metrics

Abstract View : 472 times
PDF Download : 212 times

DOI: 10.24871/261202555-58

Refbacks

  • There are currently no refbacks.