The treatment effects of acotiamide in esophagogastric outflow obstruction: a prospective longitudinal observational study

We have found that an altered lower esophageal sphincter (LES) accommodation response is an underlying cause of esophagogastric junction outflow obstruction (EGJOO). The objective of this study was to examine the treatment effect of acotiamide, a prokinetic agent which improves impaired gastric accommodation in functional dyspepsia, in patients with EGJOO. A prospective observational longitudinal study was conducted between October 2014 and March 2020. Acotiamide (100 mg, 3 times a day) was administered to 25 patients with EGJOO for 4 weeks. High-resolution manometry (HRM) was performed just before and after 4 weeks of treatment. As the primary outcome, the extent of integrated relaxation pressure (IRP) after treatment (14.6, 12.1–22.0 mmHg) was significantly lower than that before treatment (19.4, 17.1–27.4 mmHg). The extent of LES accommodation index after treatment (32.7, 21.0–40.0 mmHg) was also significantly lower than that before treatment (39.3, 31.2–50.2 mmHg). Acotiamide normalized the IRP (