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Aim: to evaluate the efficacy and safety of the new prokinetic drug acotiamide in the treatment of functional dyspepsia.Key findings. Acotiamide is an antagonist of inhibitory muscarinic receptors of type 1 and 2 and a reversible inhibitor of acetylcholinesterase activity. In patients with functional dyspepsia acotiamide normalizes the accommodation of the fundal part of the stomach and accelerates delayed gastric emptying. The conducted studies have confirmed the higher efficacy of acotiamide compared to placebo in reducing the severity of such symptoms of functional dyspepsia as a feeling of epigastric postprandial fullness and bloating, early satiation. The advantage of acotiamide in comparison to other prokinetics (in particular, metoclopramide and domperidone) is the high safety of use and the absence of influence on the duration of the Q-T interval.Conclusion. The high efficacy and safety of the application makes it advisable to use acotiamide in the treatment of patients with functional dyspepsia.

Abstract Background Since the previous network meta-analysis assessing the efficacy of prokinetics for functional dyspepsia (FD), there have been a number of new studies and cinitapride is a new prokinetic agent for FD. This updated meta-analysis aimed to explore the efficacy and safety of prokinetics for FD. Methods An updated study search in Pubmed, EMBASE, Cochrane Library and Web of Science was conducted in literatures published from July 2015 to March 2023. Randomized controlled trials investigating the use of prokinetics in adult FD patients were included. The primary outcome was the total efficacy rate and the secondary outcome was adverse events. A Bayesian network meta-analysis was performed using R software. Results A total of 28 studies were included. Network meta-analysis showed that metoclopramide had a higher total efficacy rate than mosapride (OR: 3.53, 95%CI: 1.70–7.47), domperidone (OR: 2.29, 95%CI: 1.16–4.63), itopride(OR: 2.77, 95%CI: 1.41–5.59), acotiamide(OR: 2.63, OR: 1.33–5.36), and placebo(OR: 5.68, 95%CI: 2.98–11.10), however similar to cinitapride (OR: 1.62, 95%CI: 0.75–3.53). Cinitapride had a higher total efficacy rate than mosapride (OR: 2.18, 95%CI: 1.16–4.14) and placebo (OR: 3.52, 95%CI: 2.01–6.24). Cinitapride had lower risk of total adverse events than domperidone. There was no difference in the risk of drug-related adverse events between the prokinetics. Conclusions Metoclopramide and cinitapride may have a better efficacy than other prokinetics in the treatment of FD, and cinitapride may have a lower risk of total adverse events. Further studies using uniform definitions or validated tools to measure the total efficacy rate are needed.

Acotiamide is a prokinetic with a novel mechanism of action an antagonist of muscarinic M1 and M2 receptors and an acetylcholinesterase inhibitor. Acetylcholine is the central mediator of the tone of the muscular components of the gastrointestinal tract, increasing its motor activity. Blockade of presynaptic M1 and M2 receptors neutralizes the inhibitory effect of the feedback mechanism on the acetylcholine synthesis, while inhibition of acetylcholinesterase in the synaptic cleft reduces the acetylcholine degradation. Currently, the clinical efficacy of acotiamide in the population of patients with functional dyspepsia is demonstrated in more than 10 clinical studies in different regions of the world, demonstrating a reduction of the symptoms of the disease during treatment with this agent and an improvement in the quality of life of patients. In addition, the combination of acotiamide with proton pump inhibitors optimizes the management of patients with gastroesophageal reflux disease.

The aim of the present study was to evaluate cardiac indices using M-mode echocardiography after the administration of metoclopramide and ondansetron in donkeys. For this purpose, 10 apparently healthy Egyptian Baladi donkeys (Equus asinus) were used in a crossover prospective study. Two trials were conducted with the administration of metoclopramide hydrochloride anhydrous at a dose of 0.25 mg Kg−1 and ondansetron hydrochloride sodium at a dose of 0.15 mg Kg−1. The control group (placebo) received a total volume of 50 mL of isotonic saline at 0.9%. An echocardiographic examination was performed using a Digital Color Doppler Ultrasound System equipped with a 2–3.9 MHz phased array sector scanner transducer. In general, the fractional shortening (FS%) was significantly affected by the time for metoclopramide (p = 0.031) and ondansetron (p = 0.047) compared with those of placebo, with treatment with metoclopramide provoking significantly higher percentages of FS% at T60 (p = 0.009) and T90 (p = 0.028) compared with those for ondansetron and placebo. The interaction of time x treatment also showed a statistically significant alteration of FS% (p

Aim: to analyse the document of the European Society for Neurogastroenterology and Motility consensus on gastroparesis, held in 2020.Key findings. The evaluation of the voting results on the submitted statements of the consensus meeting shows that there is a high level of agreement among the experts regarding the definition of gastroparesis, the main diseases in which it occurs, and the existing diagnostic methods. At the same time, there is a divergence of views regarding the role of individual pathogenetic factors of gastroparesis and their relationship with clinical symptoms, as well as the effectiveness of drugs of various groups and other treatment methods.Conclusion. The pathophysiological mechanisms of gastroparesis and the effectiveness of various treatment methods need further research.

Gabrio Bassotti,1 Paolo Usai Satta,2 Massimo Bellini3 1Gastroenterology & Hepatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy; 2Gastrointestinal Unit, “G. Brotzu” Hospital, Cagliari, Italy; 3Gastrointestinal Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, ItalyCorrespondence: Gabrio BassottiClinica di Gastroenterologia ed Epatologia, Ospedale Santa Maria della Misericordia, Piazzale Menghini, 1, San Sisto (Perugia), 06156, ItalyEmail gabassot@tin.itAbstract: Chronic idiopathic constipation (CIC) is a common functional bowel disorder characterized by difficult, infrequent, and/or incomplete defecation. It has a great impact on the quality of life and on health care system and represents a heavy economic burden. The diagnosis is based on symptoms, classified by the Rome IV criteria. The aim of this review was to evaluate the current therapeutic guidelines for adult CIC and highlight new emerging treatments. In detail, European, French, Spanish and Korean guidelines have been identified and compared. Osmotic laxatives, and in particular polyethylene glycol, represent the first-line therapeutic approach. Stimulant laxatives are recommended as a second-line therapy. Pelvic floor rehabilitation is recommended in patients with ano-rectal dyssynergia. In patients who fail to improve with pharmacological therapies sacral nerve stimulation is considered as last chance before surgery. Surgical approach has however limited indications in selected cases. Inertia coli refractory to any approach and obstructed defecation are two subtypes which can benefit from surgery. Among emerging agents, prucalopride, a prokinetic agent, is recommended as a second-line treatment in refractory CIC patients. In addition, the secretagogues linaclotide and plecanatide and the bile acid transported inhibitor elobixibat can be effective in patients not responsive to a second-line therapeutic regimen, although they are not worldwide commercially available.Keywords: chronic idiopathic constipation, guidelines, osmotic laxatives, pelvic floor rehabilitation, prokinetics, secretagogues

Introduction. Chronic gastritis is one of the most common problems in gastroenterology and general medical practice. In this study, we tried to analyze the actions of therapists in relation to patients with symptoms of dyspepsia, to assess how different symptom complex affects the choice of therapy and the diagnostics.Aim. Identifying the process of a preliminary diagnosis by symptoms, determining the ability of physicians to differentiate clinical syndromes, and determining the approaches to empirical therapy at first visit and following the “test and treat” strategy aimed at identifying the H. pylori infection.Materials and methods. The study was conducted using the CAWI (Computer-assisted Web Interview) method. Each physician who agreed to participate in the study received a link to take the survey and independently entered the answers to the questions formulated by the researcher. The descriptions of three profiles of adult patients with suspected gastritis diagnosis who applied for the first time were suggested: 1) a patient with a pain syndrome and dyspepsia symptoms; 2) a patient with dyspepsia symptoms; 3) a patient with a pain syndrome.Results. The study involved 205 physicians from 33 cities of Russia. The most commonly assumed diagnosis was gastritis: 50% of responders suggested it for patient 1, 51% – for patient 2, and 40% – for patient 3. Despite the unambiguous description of the delayed motility symptoms in patients 1 and 2, the most commonly assumed diagnoses did not reflect the presence of a problem. At the same time, physicians did not conduct diagnostic tests for H. pylori infection in case of patients 1 and 3 with obvious symptoms of gastritis. In case of infection, physicians suggest prescribing eradication drugs to each patient, and the most popular pharmacological group suggested were PPIs (91%). However, every tenth physician suggested eradication without PPIs.Conclusion. The results of the survey indicate a lack of awareness among therapists about the symptoms of delayed motility. This leads to the symptomatic pharmacotherapy, which does not provide the rupture of pathogenetic mechanisms

The review article describes the epidemiology, clinical picture, pathogenesis, approaches to the diagnosis and treatment of chronic gastritis and functional dyspepsia. Chronic gastritis is an unreasonably common diagnosis in our clinical practice, which is diagnosed in patients with disturbing dyspeptic complaints. According to the agreement documents, chronic gastritis is primarily a morphological concept. Chronic gastritis has no pathognomonic clinical signs and should be diagnosed during the histological examination of the gastric mucosa. Functional dyspepsia is a diagnosis that reflects the presence of a certain symptom complex (pain or burning sensation in the epigastrium, a feeling of fullness or early satiety) in the absence of diseases that could explain the symptoms. Secondary dyspepsia is diagnosed in patients with organic diseases of the upper gastrointestinal tract, metabolic or systemic diseases that cause dyspeptic syndrome. In the process of examining a patient with disturbing dyspeptic complaints, it is advisable for the doctor to use the diagnosis “unspecified dyspepsia” – a preliminary diagnosis before laboratory and instrumental examination aimed at identifying the cause of the dyspeptic syndrome. Dyspepsia associated with H. pylori is diagnosed in patients with H. pylori infection. The diagnosis is revised over time and is competent if complaints have been relieved within 6 months after effective H. pylori eradication.The main drugs for the treatment of patients with dyspeptic complaints are proton pump inhibitors and prokinetics. Omeprazole with domperidone sustained release (SR) in a fixed dose combination is characterized by optimal efficacy and a good safety profile in patients with both functional and secondary dyspepsia and ensures a high level of treatment adherence.

The definition of gastritis is based on the histological features of the gastric mucosa. This is not the erythema observed during gastroscopy, and there are no specific clinical manifestations or symptoms that determine it. The modern classification of gastritis is based on time (acute and chronic), histological features, anatomical distribution and the main pathological mechanisms. Acute gastritis will develop into chronic if left untreated. Helicobacter pylori (H. pylori) is the most common cause of gastritis worldwide. However, from 60 to 70% H. pylori-negative subjects with functional dyspepsia or non-erosive gastroesophageal reflux were also found to have gastritis. H. pylori-negative gastritis is considered when a person meets all four of these criteria: negative triple staining of biopsies of the gastric mucosa, no history of treatment of H. pylori. In these patients, the cause of gastritis may be associated with tobacco smoking, alcohol consumption and / or the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or steroids. Other causes of gastritis include autoimmune gastritis associated with antibodies of serum anti-parietal and anti-internal factor; organisms other than H. pylori, such as Mycobacterium avium intracellulare, Herpes simplex and Cytomegalovirus; gastritis caused by acid reflux; Rare causes of gastritis include collagen gastritis, sarcoidosis, eosinophilic gastritis and lymphocytic gastritis. The clinical picture, laboratory studies, gastroscopy, as well as histological and microbiological examination of tissue biopsies are important for the diagnosis of gastritis and its causes. Treatment of gastritis caused by H. pylori leads to the rapid disappearance of polymorphic-nuclear infiltration and a decrease in chronic inflammatory infiltrate with gradual normalization of the mucous membrane. Other types of gastritis should be treated based on their etiology.

Functional dyspepsia is one of the most common functional disorders of the gastrointestinal tract, which resulted from impaired motor skills, visceral hypersensitivity, increased mucosal permeability, disorders of the autonomic nervous system, etc. There is no specific therapy for this disease, which often leads to the irrational use of various groups of drugs. Drug therapy is recommended only during periods of symptoms. The main options of pharmacotherapy include the use of proton pump inhibitors, phytotherapeutic drugs, eradication therapy of Helicobacter pylori. Against the background of possible motor disorders, prokinetics are also one of the possible treatment options, but cisapride has long been withdrawn from sale due to cardiotoxicity, the use of domperidone and metoclopramide is limited due to side effects, especially with long-term therapy, so currently the only prokinetic that can be used in everyday clinical practice is itopride. In refractory cases, tricyclic antidepressants and psychotherapeutic approaches are another effective treatment option.

The article presents a clinical case of a 23-year-old patient with an extremely severe congenital form of chronic intestinal pseudoobstruction coupled with a neuromyopathy,colon malrotation, malabsorption, bacterial overgrowth syndrome, cholelithiasis and gastrostasis, which excluded bowel transplantation. Long-term treatment in the intensive care unit with combined, mainly parenteral nutrition for 6 months, using antibiotics, prokinetics, intestinal decompression allowed to achieve partial stabilization of the patients condition and transfer to home treatment with the continuation of adequate complex therapy.

Abstract Background Bacterial translocation is considered the pathophysiological hallmark in the development of spontaneous bacterial peritonitis (SBP). Prokinetics can increase gastrointestinal (GIT) motility, reduce small bowel transit time, decrease bacterial translocation, and the possibility of SBP. The aim of this work was to compare the effectiveness and safety of itopride and norfloxacin versus norfloxacin only in secondary prophylaxis for cirrhotic ascitic patients with spontaneous bacterial peritonitis. Results Regarding the baseline clinical manifestations and laboratory investigations, there was no significant difference between both groups. The incidence of a recurrent SBP in group I, who had received itopride plus norfloxacin, reduced with a significant difference than other group II (P=0.018). The median time for recurrence of SBP was highly longer in group I than group II with a significant difference (P=0.042). Conclusions The combined usage of itopride with norfloxacin in patients with cirrhosis and ascites can decrease the occurrence of a recurrent SBP and significantly improve the survival of patients. Trial registration ClinicalTrials.gov Identifier: NCT04161768 .

Proton pump inhibitors (PPIs) are baseline drugs for induction and maintenance of remission in gastroesophageal reflux disease (GERD). PPIs have proven to be highly effective in healing esophageal mucosal lesions and relieving the symptoms of the disease in most cases. However, according to the literature data, the incidence rate of clinical ineffectiveness of PPIs in the form of partial or complete persistence of current symptoms during administration of standard doses of PPIs ranges from 10 to 40%. Optimization of GERD therapy in PPI refractory patients is a significant challenge. In most cases, experts advise to increase a dose / dosage frequency of PPIs, switch to CYP2C19-independent PPIs (rabeprazole, esomeprazole, dexlansoprazole), add an esophagoprotective or promotility agents to therapy. At the same time, these recommendations have a limited effect in some patients, which opens up opportunities for looking for new solutions related to the optimization of GERD therapy. Today there is growing evidence of the relevance of the role of disruption of the cytoprotective and barrier properties of the esophageal mucosa in the genesis of GERD and the formation of refractoriness. Intercellular contacts ensure the integrity of the barrier function of the esophageal mucosa to protect it from various exogenous intraluminal substances with detergent properties. Acid-peptic attack in patients with GERD leads to alteration of the expression of some tight junction proteins in epithelial cells of the esophageal mucosa. The latter leads to increased mucosal permeability, which facilitates the penetration of hydrogen ions and other substances into the submucosal layer, where they stimulate the terminals of nerve fibers playing a role in the induction and persistence of the symptoms of the disease. The above evidence brought up to date the effectiveness study of the cytoprotective drugs with tropism to the gastrointestinal tract, as part of the combination therapy of GERD.

Abstract Background Motility disorders of upper gastrointestinal tract are common in critical illness and associated with significant clinical consequences. However, detailed quantitative and qualitative analyses of esophageal motor functions are lacking. Therefore, we aimed to characterize the key features of esophageal motility functions using high-resolution impedance manometry (HRIM) and to evaluate an objective link between esophageal motor patterns, gastric emptying, and gastroesophageal reflux. We also studied the prokinetic effects of metoclopramide. Methods We prospectively performed HRIM for 16 critically ill hemodynamically stable patients. Patients were included if they had low gastric volume (LGV; 500 mL/24 h, n = 8). The HRIM data were collected for 5 h with intravenous metoclopramide administration (10 mg) after the first 2 h. Results The findings were grossly abnormal for all critically ill patients. The esophageal contraction vigor was markedly increased, indicating prevailing hypercontractile esophagus. Ineffective propulsive force was observed for 73% of esophageal activities. Panesophageal pressurization was the most common pressurization pattern (64%). Gastroesophageal reflux predominantly occurred with transient lower esophageal sphincter relaxation. The common features of the LGV group were a hyperreactive pattern, esophagogastric outflow obstruction, and frequent reflux. Ineffective motility with reduced lower esophageal sphincter tone, and paradoxically fewer reflux episodes, was common in the HGV group. Metoclopramide administration reduced the number of esophageal activities but did not affect the number of reflux episodes in either group. Conclusion All critically ill patients had major esophageal motility abnormalities, and motility patterns varied according to gastric emptying status. Well-preserved gastric emptying and maintained esophagogastric barrier functions did not eliminate reflux. Metoclopramide failed to reduce the number of reflux episodes regardless of gastric emptying status. Trial registration ISRCTN, ISRCTN14399966. Registered 3.9.2020, retrospectively registered. https://www.isrctn.com/ISRCTN14399966 .

Chronic intestinal pseudo-obstruction a rare violation of the motor skills of the gastrointestinal complex, similar to mechanical obstruction, but without a mechanical obstacle. The development of chronic intestinal pseudo-obstruction is caused by a disturbance on the part of the smooth muscles and the nervous system of the gastrointestinal system. Common symptoms include constipation, abdominal pain, nausea, vomiting, bloating. Violation of peristalsis leads to food stagnation in the hinges of the small intestine, their dilation, the development of bacterial insemination syndrome. Eating disorders, bacterial contamination syndrome (CDDs) lead to impaired suction syndrome, cahexia. Treatment is aimed at providing adequate nutrition, the use of drugs that activate motor skills, suppress the growth of microbes in the small intestine, the implementation of intestinal decompression. Surgical treatment: resection of the affected segment of the gut. In the refractory course of the disease intestinal transplantation.

A review of current data suggests that the attention to the problem of dyspepsia is huge. The definition of functional dyspepsia was given in the Rome IV criteria, according to which two of its main options are distinguished – epigastric pain syndrome and postprandial distress syndrome. The term “uninvestigated dyspepsia” is important, which means the presence of dyspepsia symptoms in patients who have not performed diagnostic procedures to identify the organic causes of the pathology. The prevalence of uninvestigated dyspepsia in the world is about 21%. The prevalence of functional dyspepsia is significantly lower than the prevalence of uninvestigated dyspepsia and fluctuates around 10%. The risk factors for dyspepsia are usually tobacco smoking, non-steroidal anti-inflammatory drugs and/or aspirin, and Helicobacter pylori infection. The concept of the pathogenesis of functional dyspepsia undergoes significant changes. By analogy with the pathophysiology of irritable bowel syndrome, lesions of the relationship between the modulation of the cerebral cortex and the signal system of the gastroduodenal zone, the association of sluggish immune inflammation in the duodenum with motility and sensory activity of the stomach are most actively studied. The treatment of functional dyspepsia is a complex problem and changes after new ideas about its pathogenesis. Modern meta-analyzes have made it possible to expand the indications for the proton pump inhibitors administration, which can be actively used not only for the treatment of epigastric pain syndrome, but also for postprandial distress syndrome. Along with the required Helicobacter pylori eradication, there are reasons for the use of probiotics and antibiotics for the dyspepsia treatment.

Functional dyspepsia (FD) is one of the dysregulatory lesions of the upper digestive tract. This syndrome has fairly well-defined clinical manifestations that include borderline psychopathological disorders. Its diagnosis becomes a method for ruling out organic gastrointestinal and mental illnesses. Treatment for FD is complex and includes a behavioral component, prokinetics, myotropic spasmolytics, antisecretory drugs, and tricyclic antidepressants. The efficiency of therapy directly depends on a physician's ability to choose an individualized regimen.

Aim. To present the materials of an Expert Council, which was held on September 23, 2019 in Istanbul (Turkey) under the auspices of a World Gastroenterology Organisation congress and the support of the Abbott company.General provisions. During the work of the Expert Council, the role of motility disorders of the stomach and duodenum, intestines, gall bladder and the sphincter of Oddi in the development of functional diseases of the digestive system, such as functional dyspepsia (FD), irritable bowel syndrome (IBS), biliary dyskinesia (BD) was discussed, and the effectiveness of antispasmodics and prokinetics in their treatment was shown. At the same time, the advantages of the mebeverin antispasmodic drug, as well as the high efficiency and safety of the itopride hydrochloride prokinetic drug were noted. It is emphasized that, at the stage of a diagnostic search in the absence of “alarm symptoms” in patients with suspected FD, IBS, and BD, these drugs can be prescribed empirically.Conclusions. When selecting pharmacotherapy for patients with motor impairment, it is extremely important to consider the nature of these disorders. The use of modern medical preparations, which are characterized by a high level of safety and the targeted action towards a specific motility disorder, allows optimal therapy results to be achieved with minimal risks for the patient.

Introduction It is strongly recommended that laxatives be routinely prescribed for the prevention of opioid-induced constipation (OIC). The evidence supporting the effectiveness of prokinetics for this indication is sparse. This study aims to verify if itopride, added to preventive OIC therapy, increases the effectiveness of the prevention of opioid-induced constipation in adult palliative care patients. Material and methods In a questionnaire-based observational study, all patients received regular laxatives plus one of the following: oxycodone/naloxone (OXN); itopride (ITP); or oxycodone/naloxone + itopride (OXN + ITP). The primary measure was the decrease in the necessity of laxative use in a 0–4 scale assessed after 7 days of treatment. Results Ninety-two patients met the inclusion criteria in the four groups: OXN (n = 12), ITP (11), OXN + ITP (9), and the control group (laxatives only if needed) (60). The necessity of laxatives decreased in groups where itopride was used, with a statistically significant difference versus control, oxycodone/naloxone (p = 0.009), or in combination. The OXN did not decrease laxative use (p = 0.22). Conclusions All interventions appeared similarly effective in the prevention of OIC. However, adding itopride, but not oxycodone/naloxone, resulted in a decrease in the necessity of laxative use in OIC patients, and it seems to be valuable in this often refractory condition. Randomised, controlled trials would be valuable to obtain good quality evidence without systematic bias.

Functional dyspepsia (FD) is one of the most common gastroenterological diseases. The article presents modern views on the pathogenesis of the disease. It is shown that disorders of motor skills (retardation of voiding function, disturbance of relaxation accommodation) and stomach sensitivity (visceral hypersensitivity to stretching) are considered to be one of the main pathophysiological mechanisms of FD. The authors present a modern algorithm of treatment of patients with FD, based on the clinical recommendations of the Rome Consensus IV revision (2016) and the Russian Gastroenterological Association (2017). The strategy of differentiated use of pharmaceuticals for different variants of FD is considered.

Danny J Avalos,1 Irene Sarosiek,1 Priyadarshini Loganathan,2 Richard W McCallum1 1Division of Gastroenterology, Center for Neurogastroenterology and GI Motility, Texas Tech University Health Sciences Center, El Paso, TX, USA; 2Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA Abstract: Diabetic gastroparesis (DMGP) is a condition of delayed gastric emptying after gastric outlet obstruction has been excluded. Symptoms of nausea, vomiting, early satiety, bloating, and abdominal pain are associated with DMGP. Uncontrolled symptoms can lead to overall poor quality of life and financial burdens on the healthcare system. A combination of antiemetics and prokinetics is used in symptom control; metoclopramide is the main prokinetic available for clinical use and is the only U.S. Food and Drug Administration-approved agent in the United States. However, a black box warning in 2009 reporting its association with tardive dyskinesia and recommending caution in chronically using this agent beyond 3 months has decreased its role in clinical practice. There is an unmet need for new prokinetics with good efficacy and safety profiles. Currently, there are several new drugs with different mechanisms of action in the pipeline that are under investigation and show promising preliminary results. Surgically combining gastric electrical stimulation with pyloroplasty is considered “gold” standard. Advances in therapeutic endoscopic intervention with gastric per-oral endoscopic pyloromyotomy have also been shown to improve gastric emptying and gastroparesis (GP) symptoms. In this review, we will comment on the challenges encountered when managing patients with DMGP and provide an update on advances in drug development and endoscopic and surgical interventions. Keywords: bloating, fullness, nausea, vomiting, Enterra, diabetes

The article presents a current algorithm for treating patients with functional dyspepsia, which is based on the clinical guidelines of the Rome IV Revision (2016), the Russian Gastroenterological Association (2017), and the American and Canadian Associations of Gastroenterologists (2017). It provides evaluation of the options for eradication of Helicobacter pylori infection as one of the stages of management of patients with this functional disorder. It also discusses the strategy for differentiated use of proton pump inhibitors and prokinetics for various variants of functional dyspepsia.

Functional gastrointestinal disorders are currently being considered as the most common pathology of the gastrointestinal tract. Symptoms that may be related to the gastroduodenal region, represent one of the major subgroups among functional gastrointestinal disorders, in which the functional dyspepsia rightly maintains leading positions syndrome. Pathogenetic factors of functional dyspepsia and other functional gastrointestinal disorders, which can be regarded as proven at the moment, are the dysmotility of the gastrointestinal tract, which determines the feasibility of using in the basic treatment of these diseases medications that affect motor function of the gastrointestinal tract and preventing anastaltic contractions of the smooth muscles, which are combined into a group of prokinetic. With comorbidity positions, clinical efficacy and drug safety is a priority itopride hydrochloride prokinetics in treatment of functional dyspepsia and other related functional gastrointestinal disorders.

Functional dyspepsia (FD) is a disease with different prevailing pathogenetic mechanisms. The prevalence of FD varies widely from 10 to 30 % of the population, depending on the country and the surveyed cohort. There are two forms of FD: postprandial distress syndrome manifested by a fullness/early satiety after eating, and epigastric pain syndrome — pain/burning in the epigastrium, which may worsen after eating. In a significant part of patients with FD, there are manifestations of both syndromes, the so-called overlap, or a mixed type. In the Ukrainian population, all patients with dyspepsia should be diagnosed and, if found, — undergo mandatory eradication of H.pylori. In patients with persistent symptoms or in those initially not infected with H.pylori, in our opinion, it is advisable to use the combination of proton pomp inhibitor and prokinetic as starting treatment. In our country, a fixed combination of omeprazole and domperidone is available in two dosages. This is Omez D containing 10 mg of both components and a more highly dosed Omez DSR containing 20 mg of omeprazole and 30 mg of domperidone in the form of sustained-release pellets.

Abstract Background Controversies persist regarding the effect of prokinetics for the treatment of functional dyspepsia (FD). This study aimed to assess the comparative efficacy of prokinetic agents for the treatment of FD. Methods Randomized controlled trials (RCTs) of prokinetics for the treatment of FD were identified from core databases. Symptom response rates were extracted and analyzed using odds ratios (ORs). A Bayesian network meta-analysis was performed using the Markov chain Monte Carlo method in WinBUGS and NetMetaXL. Results In total, 25 RCTs, which included 4473 patients with FD who were treated with 6 different prokinetics or placebo, were identified and analyzed. Metoclopramide showed the best surface under the cumulative ranking curve (SUCRA) probability (92.5%), followed by trimebutine (74.5%) and mosapride (63.3%). However, the therapeutic efficacy of metoclopramide was not significantly different from that of trimebutine (OR:1.32, 95% credible interval: 0.27–6.06), mosapride (OR: 1.99, 95% credible interval: 0.87–4.72), or domperidone (OR: 2.04, 95% credible interval: 0.92–4.60). Metoclopramide showed better efficacy than itopride (OR: 2.79, 95% credible interval: 1.29–6.21) and acotiamide (OR: 3.07, 95% credible interval: 1.43–6.75). Domperidone (SUCRA probability 62.9%) showed better efficacy than itopride (OR: 1.37, 95% credible interval: 1.07–1.77) and acotiamide (OR: 1.51, 95% credible interval: 1.04–2.18). Conclusions Metoclopramide, trimebutine, mosapride, and domperidone showed better efficacy for the treatment of FD than itopride or acotiamide. Considering the adverse events related to metoclopramide or domperidone, the short-term use of these agents or the alternative use of trimebutine or mosapride could be recommended for the symptomatic relief of FD.

The adolescence is characterized by high rates of gastroenterological morbidity due to physiological characteristics of the body and social and psychological status of the teenager. Dyspepsia takes the leading position in the structure of functional pathology. Studies have shown the role of family, unhealthy habits and addictions in the development of this disorder. One should also bear in mind that the adolescence is characterized by an increase in organic pathology. There is a close association of the functional dyspepsia and the premorbid background, such as autonomous dysfunction and vertebral abnormalities. The use of cholinolytics, prokinetics, opioid receptor antagonists, antacids and anti-secretory agents seems rational for treatment of dyspepsia. If the above mentioned groups of agents lack efficacy, the second line therapy is proposed, which includes tricyclic antidepressants.

Small intestinal bacterial overgrowth (SIBO) is common in patients with systemic sclerosis (SSc) yet often goes underrecognized in clinical practice. In patients with SSc, untreated SIBO may result in marked morbidity and possible mortality. The pathogenesis of SIBO is multifactorial and relates to immune dysregulation, vasculopathy, and dysmotility. This article reviews various diagnostic approaches and therapeutic options for SIBO. Treatment modalities mainly include prokinetics, probiotics, and antibiotics.

Introduction: Gastroesophageal Reflux Disease (GERD) is a common public health problem causing increased economic burden and decreased quality of life. Proton Pump Inhibitor (PPI) and prokinetics are the frequently used medications. The efficacy and safety of combined prokinetic and PPI therapy for GERD remains controversial. Aim: The study was conducted to perform pharmacoeconomic evaluation of Pantoprazole and Pantoprazole plus Domperidone in the management of GERD which helps to provide quality care within limited financial resources. Materials and Methods: This RCT was conducted on 80 patients suffering from GERD. These patients were randomly divided into two groups; Pantoprazole (40 mg once daily) and, Pantoprazole plus Domperidone (40 mg+30 mg once daily), respectively. The clinical outcomes were observed and analysed after two weeks of treatment. Cost-effectiveness ratio for pantoprazole and pantoprazole plus Domperidone was calculated by dividing the cost of treatment by its clinical outcome that is, Frequency Scale for the Symptoms of GERD (FSSG) score. Cost minimization analysis was done in accordance with the cost of both drugs available in market (over the counter) and Hospital pharmacy. All the data was recorded in the entry form and presented as mean±SEM/SD for numerical data, and proportion (%) for the categorical data. In all tests mean values of test groups (A and B) compared with Student's paired t-test. Results: After two weeks of treatment, the total improvement rate was found to be higher in Pantoprazole plus Domperidone group than in Pantoprazole group (improvement score 12.93 vs 11.32 but statistically not significant, p-0.21). But Pantoprazole was found to be more cost effective than Pantoprazole plus Domperidone group (ACER 9.7 vs 11.2). Cost minimisation analysis showed that Pantoprazole is the most economical medicine in hospital pharmacy as well as available in market. Conclusion: Pantoprazole monotherapy is more cost effective than combination of Pantoprazole with Domperidone in GERD patients. Substitution by Pantoprazole alone would be expected to produce cost savings. A combination should be preferred for PPI resistant GERD, patients with nausea and vomiting, in the subgroup of severely symptomatic patients.

Introduction. Diabetes mellitus (DM) is considered to be one of the most serious problems in internal medicine due to multiple organ lesions and irreversible changes in the functioning of the organism. At present, despite the continuous advancement in medical science pathogenetic mechanisms of the development and progression of gastrointestinal form of autonomic neuropathy, particularly one of its manifestations – diabetic gastroparesis (DG) remains insufficiently studied. Purpose of the study. In the scientific literature there are insufficient data on the clinical efficacy of itopride hydrochloride in patients with impaired motor-evacuation function (MEF) of the stomach. There are no answers to the questions about pathogenetic mechanisms of possible effects of prokinetics on the parameters of glycemic control, the incidence of hypoglycemic events, the progression of gastrointestinal manifestations, etc. Therefore, the objective of the research was to determine therapeutic efficacy of itopride in treatment of gastroparesis considering the state of carbohydrate metabolism in patients with type 2 diabetes mellitus. Materials and research methods. To clarify the relationship between the results of itopride hydrochloride therapy and the dynamics of changes in carbohydrate metabolism were examined 48 patients with type 2 DM. They were divided into two groups. In addition to the standard 6-week course of pathogenetically grounded therapy patients of Group I (n = 24) received itopride hydrochloride at a daily dose of 150 mg (50 mg three times a day 30 min before their main meal). Patients of Group II (the control group) (n = 24) underwent the standard therapy without using medicines affecting MEF of the stomach. The clinical severity of DG was determined using the questionnaire ″Patient Assessment of Gastrointestinal Disorders-Symptom Severity Index″ (PAGI-SYM), which allows the patient to assess the severity of symptoms by himself. According to the survey (D-ABS) the prevalence and intensity of the hypoglycemic episodes were determined. To assess MEF of the stomach all the patients underwent 13C-octanoic acid breath test. Results of the investigation and their discussion. According to the results of additional methods of examination there was a direct correlation between the mean PAGI-SYM scores and the results of 13C-octanoic acid breath test (r = 0.63 ± 0.03, p < 0.001). There was also a strong direct correlation between the state of compensation of carbohydrate metabolism (НbA1C, %) and the degree of slowing of gastrointestinal motility according to the results of 13C-octanoic acid breath test (r = 0.64 ± 0.03, p < 0.001). Thus, the course of DG depends on the effectiveness of glycemic control. Total PAGI-SYM scores indicated the positive effect of treatment which was significantly different in patients of Group I before (14.21 ± 3.28 points – moderate DG) and after the treatment (7.28 ± 0.9 points – mild DG) compared to the control group. The results of 13C-octanoic acid breath test confirmed the effectiveness of a 6-week course of treatment with itopride hydrochloride at a daily dose of 150 mg (50 mg three times a day 30 min before a meal) with recovery of gastrointestinal motility (according to treatment Т ½ – 98.24 ± 3.14 min, in dynamics Т ½ – 68.32 ± 3.55 min; р < 0.05) in patients of Group I. In patients of Group II (the control group) the normalization of MEF of the stomach after the course of treatment was not observed (before treatment Т ½ – 97.23 ± 2.61 min, after treatment Т ½ – 92.12 ± 0.16 min; р >0.05). Conclusions. The effectiveness of using itopride hydrochloride at a daily dose of 150 mg has been proven. It has been established that it contributes to normalizing MEF of the stomach in patients with type 2 DM and signs of DG as well as achieving better compensation of carbohydrate metabolism of both prandial and postprandial glucose levels. The possibility of using prokinetic agents to prevent the labile course of DM should be taken into consideration.

The article is devoted to the etiology, pathogenesis, clinical symptoms, approaches to diagnosis, therapy and prevention of functional dyspepsia.

The aim of review. To demonstrate that esophageal and stomach motility disorders play one of basic roles in pathogenesis of gastroesophageal reflux disease (GERD).Key points. Gastroesophageal reflux disease is related to the group of acid-related diseases, however esophageal and stomach motility disorders play important role in its development. In patients with GERD disorders of primary and secondary peristalsis of the esophagus, increase of frequency of transient lower esophageal sphincter relaxations and pathologic bile refluxes are common.Conclusion. Numerous studies are devoted to investigation of gastroesophageal reflux disease. The role of motility disorders of the esophagus and the stomach in its pathogenesis, and origin of symptoms of reflux disease and other gastro-intestinal functional diseases, in particular the functional dyspepsia is actively discussed. At upper gastro-intestinal motility disorders application of prokinetics is effective, e.g. itopride hydrochloride, that reduces frequency of transient lower esophageal sphincter relaxations due to decrease of intragastric pressure, activates propulsive stomach motility and eliminates duodenogastric and duodenogastroesophageal refluxes.

The aim of review. To present modern data on the pathophysiological mechanisms causing functional dyspepsia (FD) syndrome.Key points. Nowadays FD is considered to be a complex multifactor process which cause and effect relationships are under continuous active study. Disorders of stomach motility (delay of evacuation, disorders of relaxation accommodation) and sensitivity (visceral hypersensitivity to distention) are considered to be the basic pathophysiological mechanisms of FD. These changes develop approximately in 40% of FD patients. Besides that, alteration of duodenal sensitivity to hydrochloric acid and lipids can play significant role in genesis of FD.Conclusion. Mechanisms of FD are based on multiple heterogenous disorders of motor and sensitive functions of the stomach and duodenum. Due to major role of stomach motility disorders prokinetics are the priority drugs for treatment of FD.

The aim of review. To present modern approach to treatment of functional dyspepsia (FD).Key points. Treatment of FD should be comprehensive and include general recommendations, application of drugs and psychotherapeutic methods. At a choice of specific drug clinical variant of disease should be taken into account. At pain-predominant (ulcer-like) variant antisecretory agents (first of all — proton pump inhibitors) are the drugs of choice, at postprandial distress syndrome (dysmotility-like variant) - prokinetics. In resistant cases psychotropic drugs and psychotherapeutic methods are indicated.Conclusion. Investigation of FD pathogenesis should be continued that will provide more differentiated treatment approach and improve the results.

It is not for nothing that gastroesophageal reflux disease (GERD) is called the "disease of the XXI century": it is characterized by very high incidence and affects people of different age groups. Increased incidence of adenocarcinoma of the esophagus has led researchers to identify the chain of pathological changes: GERD - Barrett's esophagus - esophageal cancer. The diagnosis of the disease is complicated by atypical extraesophageal manifestations which are often associated with diagnostic errors and inadequate therapeutic measures. This in turn increases the percentage of GERD complications, especially in socially active young patients who usually do not comply with doctor's recommendations concerning lifestyle changes, having as a result a further complication of the disease.

The aim of review. To present literature data on application of prokinetics at gastroesophageal reflux disease and functional dyspepsia.Summary. Gastroesophageal reflux disease and functional dyspepsia are considered to be the most common gastroenterological diseases. Motility disorder of gastroesophageal zone plays a leading part in pathogenesis of these diseases that assumes application prokinetics as a baseline therapy. Itopride hydrochloride has advantage over other prokinetics by three key parameters: double mechanism of action, absence of drug interactions and serious side effects.

The article deals with is one of the most common symptoms, faced by general practitioners or gastroenterologists — functional dyspepsia. Its clinical manifestations are described, attention is paid to the treatment issues. It is emphasized that the primary treatment of functional dyspepsia in most cases is an empirical, based on clinical assessment of predominance of acid-dependent or dysmotor symptoms, for which proton pump inhibitors, prokinetics, or combination drugs containing proton pump inhibitors and prokinetics, such as Omez D or Omez DCR, are administered, respectively.

На примере лечения 49 детей в возрасте от 8 до 17 лет с хроническими заболеваниями гастродуоденальной зоны (20 детей с хроническим гастродуоденитом, 14 — с эрозивным гастродуоденитом и 15 — с язвенной болезнью желудка и двенадцатиперстной кишки) и сопутствующими изменениями в поджелудочной железе рассмотрена целесообразность включения в комплексную медикаментозную терапию стимуляторов моторики (прокинетика Брюлиум лингватабс). Добавление к базисной терапии прокинетика Брюлиум лингватабс обусловлено наличием у данных пациентов нарушений моторно-эвакуаторной функции двенадцатиперстной кишки и сопутствующего синдрома дуоденостаза, поскольку именно рост давления в просвете двенадцатиперстной кишки ухудшает условия оттока из общего желчного протока и протока поджелудочной железы, что значительно повышает риск возникновения дуоденопанкреатического рефлюкса. Констатировано, что у 87 % больных основной группы уже начиная с третьих суток лечения наблюдались достоверные (р < 0,05) проявления нормализации моторики пищеварительного тракта, нивелирование симптомов тошноты и рвоты (средний балл тошноты уменьшился до 1,4 vs 3,0, а рвоты — до 1,0 vs 2,6), улучшение аппетита.

Gastroesophageal reflux (GER) is a common disorder in children with bronchial asthma. It has been identified as a potential trigger, complication and even differential diagnosis for asthma. Our aim was to find out the efficacy of the combined use of both the proton pump inhibitor esomeprazole and the antidopaminergic prokinetic domperidone versus the sole use of esomeprazole in improving asthma severity in children with difficult to treat asthma. Patients and methods: Among 178 children with difficult-to-treat asthma, GER was assessed using upper GIT endoscopy. Those who had GER were randomly divided into 2 equal subgroups the first was treated with esomeprazole for 12 weeks while the other was treated with esomeprazole and domperidone for the same period (beside the usual treatment for asthma in both groups). Childhood-asthma control test (C-ACT), forced expiratory volume in 1st second (FEV1) [% of predicted], peak expiratory flow (PEF) variability, induced sputum substance P (SP) and endoscopic reflux score (ERS) were recorded before and after the treatment. Results: Gastro-esophageal reflux (GER) was observed in about 45% of children with difficult-to-treat asthma. The C-ACT, induced sputum SP, ERS and FEV1 showed significant improvement while PEF variability showed no significant changes when comparing combination therapy subgroup (esomeprazole and domperidone) with esomeprazole only subgroup. Conclusions: Combination of domperidone and esomeprazole was more effective in improving the endoscopic reflux score, childhood-asthma control test (C-ACT) and FEV1 (% of predicted) and significantly reduced the sputum SP than the use of esomeprazole only in children with difficult-to-treat asthma.

The article tells about validity and feasibility of diagnostics of functional dyspepsia in children, relation between symptoms of dyspepsia and morphological signs of chronic gastritis, indications for anti-helicobacter therapy in children with functional dyspepsia. Etiology and pathogenesis of functional dyspepsia in children, as well as approaches to treatment, are highlighted.

The article tells about current diagnostic criteria for the syndrome of functional dyspepsia; major clinical variants of the disease and the process; modern algorithm revealing the main stages of diagnosis and treatment of patients with functional dyspepsia in clinical practice. The role of eradication of Helicobacter pylori infection in multimodal treatment of functional dyspepsia is highlighted.

The aim of review. To carry out analysis of the publications devoted to application of prokinetic drug domperidone (D) at various gastroenterological diseases.Key points. Literature data demonstrate, that dopamine receptor antagonist D is effective drug for treatment of such diseases, as functional dyspepsia, diabetic and idiopathic gastroparesis, gastroesophageal reflux disease (within combined treatment modes), and for relief of nausea and vomiting, caused by cytotoxic agents as well. Side effects at application of D are determined by risk of hyperprolactinemia, which rarely clinically relevant.Conclusion. Domperidone can be successfully applied for treatment of gastroenterological diseases accompanying primary or secondary disorders of stomach and duodenum motility.

Background/AimsIn capsule endoscopy (CE), the capsule does not always reach the cecum within its battery life, which may reduce its diagnostic yield. We evaluated the effect of mosapride citrate, a 5-hydroxytryptamine-4 agonist that increases gastrointestinal motility, on CE completion.Methods : In a retrospective study, we performed univariate and multivariate analyses for 232 CE procedures performed at our hospital. To identify factors that affect CE completion, the following data were systematically collected: gender, age, gastric transit time (GTT), nonsteroidal anti-inflammatory drug administration, previous abdominal surgery, hospitalization, use of a polyethylene glycol solution, use of mosapride citrate (10 mg), body mass index (BMI), and total recording time.Results : The univariate analysis showed that oral mosapride citrate, GTT, and BMI were associated with improved CE completion. Multivariate analyses showed that oral mosapride citrate (odds ratio [OR], 1.99; 95% confidence interval [CI], 1.01 to 3.91) and GTT (OR, 2.34; 95% CI, 1.13 to 4.87) were significant factors for improving the CE completion. Oral mosapride citrate significantly shortened the GTT and small bowel transit time (SBTT).Conclusion : sOral mosapride citrate reduced the GTT and SBTT during CE and improved the CE completion rate.

The lecture presents modern interpretation of the term "gastroesophageal reflux disease" (GERD) and Montreal classification of this disease with emphasis on non-erosive reflux disease and risk to develop Barret's esophagus which is a widely prevalent precancer condition frequently transforming into esophageal adenocarcinoma. Description is given of GERD causes, mechanisms of development, diagnostic and differential diagnostic signs of the disease, a high risk of bronchial asthma in GERD patients, basic treatment principles including healthy way of life, pharmacotherapy (antacids, alginates, prokinetics, proton pump inhibitors, etc.).

The aim of review. To illuminate state-of-the-art of issue of ischemic heart disease and reflux-esophagitis combination and options of treatment of comorbide patients.Original positions. Ischemic heart disease (IHD) and reflux-esophagitis (RE) are one of the most frequent diseases of cardio-vascular and alimentary systems. Common risk factors play important role in high prevalence of comorbide course of IHD and RE. Close anatomic position and common innervation of the heart and the esophagus trigger effect of gastroesophageal reflux on coronary vasoconstriction and disorders of heart rhythm at patients with IHD. Present studies show treatment effect, aimed on RE, at patients with IHD: decrease in number of myocardial ischemia and arrhythmia attacks. Application of prokinetics in complex treatment of RE at IHD patients is pathogenically proven. Combination of diseases requires long treatment, dictates necessity of choice of the safe agent, having no negative effect on the course of IHD.Conclusion. Mutual effect on development and progression of symptoms of cardio-vascular and alimentary diseases causes not only certain diagnostic difficulties, but also necessitates search for improvement of diagnostic and treatment methods in comorbide patients with IHD and RE.

O refluxo gastroesofágico pode afetar várias espécies e apresenta diversas etiologias, sendo as anestesias gerais uma das principais causas de esofagite em cães, devido à redução do tônus do esfíncter esofagogástrico, ocasionada por fármacos anestésicos. São fatores responsáveis pela lesão esofágica em consequência do refluxo, o tipo do material refluído, o volume, a frequência, a duração do refluxo e a integridade da mucosa esofágica. É importante prevenir o refluxo durante a anestesia, devido ao risco de ocasionar além da esofagite pós-operatória, outras graves complicações como a formação de estenoses esofágicas ou ainda resultar em pneumonia por aspiração. Para isso, é importante estabelecer protocolos anestésicos que não modifiquem a função do esfíncter esofagogástrico, bem como determinar estratégias terapêuticas que reduzam a incidência do refluxo. Neste artigo, são revisados os aspectos anatômicos e fisiológicos da junção esofagogástrica, assim como os relacionados com o refluxo gastroesofágico em cães anestesiados.Gastroesophageal reflux can affect various species and presents several etiologies, and general anesthesia can be considered one of the main causes of esophagitis in dogs, due to the reduction of the gastroesophageal sphincter tonus caused by anesthetic drugs. There are many factors responsible for the esophageal lesion due to reflux, including type of refluid material, reflux volume, frequency and duration, and esophageal mucosa integrity. It is important to prevent reflux during anesthesia because of the risk of causing not only post operatory esophagitis but also other serious complications such as formation of esophageal stenosis, or aspiration pneumonia . Thus, it is important to establish anesthetic protocols that do not modify the function of the gastroesophageal sphincter, as well as determine therapeutic strategies that could reduce reflux incidence. This research reviews the anatomic and physiological aspects of gastroesophageal junction as well as those aspects related with gastroesophageal reflux in anesthetized dogs.

The efficacy of erythromycin was assessed in the treatment of 14 children aged 4 to 13 years with refractory chronic constipation, and presenting megarectum and fecal impaction. A double-blind, placebo- controlled, crossover study was conducted at the Pediatric Gastroenterology Outpatient Clinic of the University Hospital. The patients were randomized to receive placebo for 4 weeks followed by erythromycin estolate, 20 mg kg-1 day-1, divided into four oral doses for another 4 weeks, or vice versa. Patient outcome was assessed according to a clinical score from 12 (most severe clinical condition) to 0 (complete recovery). At enrollment in the study and on the occasion of follow-up medical visits at two-week intervals, patient score and laxative requirements were recorded. During the first 30 days, the mean ± SD clinical score for the erythromycin group (N = 6) decreased from 8.2 ± 2.3 to 2.2 ± 1.0 while the score for the placebo group (N = 8) decreased from 7.8 ± 2.1 to 2.9 ± 2.8. During the second crossover phase, the score for patients on erythromycin ranged from 2.9 ± 2.8 to 2.4 ± 2.1 and the score for the patients on placebo worsened from 2.2 ± 1.0 to 4.3 ± 2.3. There was a significant improvement in score when patients were on erythromycin (P < 0.01). Mean laxative requirement was lower when patients ingested erythromycin (P < 0.05). No erythromycin-related side effects occurred. Erythromycin was useful in this group of severely constipated children. A larger trial is needed to fully ascertain the prokinetic efficacy of this drug as an adjunct in the treatment of severe constipation in children.