Adherence to an Acotiamide Therapeutic Regimen Improves Long-Term Outcomes in Patients with Functional Dyspepsia
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Satoshi Shinozaki1,2, Hiroyuki Osawa2, Hirotsugu Sakamoto2, Yoshikazu Hayashi2, Yoshimasa Miura2, Alan Kawarai Lefor3, Hironori Yamamoto2 1) Shinozaki Medical Clinic, Utsunomiya;
2) Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke;
3) Department of Surgery, Jichi Medical University, Shimotsuke, Japan
ABSTRACT Background & Aims: Long-term outcomes in patients with functional dyspepsia remain elusive. Acotiamide, a prokinetic drug, has been available in Japan since 2013. The aim of this study was to assess long-term outcomes in patients with functional dyspepsia treated with acotiamide. Methods: We retrospectively reviewed 79 consecutive patients with functional dyspepsia whose symptoms improved with acotiamide therapy and who were followed for more than one year. All patients underwent esophagogastroduodenoscopy prior to acotiamide therapy. The mean follow-up was 1.9 (range, 1.0-3.3) years. We assessed the patients’ symptom severity using the Izumo scale, which reflects changes in various abdominal symptoms. Results: At one year, dyspepsia symptoms recurred in 25% (20/79) of the patients. In multivariate analysis, severe dyspepsia was significantly associated with increased recurrence (odds ratio [OR] 15.04, 95% confidence interval [CI] 1.73-130.47, p=0.013). Continued use of acotiamide for one year diminished the recurrence of dyspepsia symptoms significantly (OR 0.16, 95%CI 0.04-0.61, p=0.006). The influence of these significant predictors on long-term outcomes was analyzed using the Kaplan-Meier method. Patients with severe dyspepsia before starting acotiamide had significantly more recurrences than those with mild symptoms (p=0.004, log-rank test). Patients who continued acotiamide therapy throughout the follow-up period had significantly fewer recurrences than those who stopped therapy (p<0.001). Conclusions: Over the long-term, patients with functional dyspepsia have a considerable rate of recurrence of dyspepsia. Severe dyspepsia before treatment increases the recurrence rates, while adherence to an acotiamide therapeutic regimen decreases recurrence rate. Key words: acotiamide – medication adherence – patient outcome assessment – dyspepsia. Abbreviations: QOL: quality of life; EPS: epigastric pain syndrome; PDS: postprandial distress syndrome; EGD: esophagogastroduodenoscopy; GERD: gastroesophageal reflux disease.