Esophageal Motility and Rikkunshito Treatment for Proton Pump Inhibitor-Refractory Nonerosive Reflux Disease: A...

Area of Science:

• Gastroenterology
• Esophageal Motility Disorders
• Reflux Disease Management

Background:

• Limited research exists on esophageal motility in proton pump inhibitor (PPI)-refractory nonerosive reflux disease (NERD).
• No established treatment strategies are available for PPI-refractory NERD.

Purpose of the Study:

• To characterize esophageal motility in PPI-refractory NERD patients using combined multichannel intraluminal impedance and esophageal manometry (MII-EM).
• To evaluate the efficacy of the gastrointestinal prokinetic agent rikkunshito (RKT) in treating PPI-refractory NERD.

Main Methods:

• Thirty NERD patients underwent MII-EM.
• PPI-refractory NERD patients received 8 weeks of RKT (7.5 g/d) treatment, followed by repeat MII-EM.
• Symptom assessment utilized the Gastrointestinal Symptom Rating Scale.

Main Results:

• PPI-refractory NERD patients showed impaired complete bolus transit, peristaltic contractions, and lower esophageal sphincter residual pressure, with deteriorated esophageal clearance.
• RKT significantly improved peristaltic contractions (P < 0.05), complete bolus transit (P < 0.01), and lower esophageal sphincter residual pressure (P < 0.05).
• RKT treatment led to significant improvements in overall Gastrointestinal Symptom Rating Scale scores (P < 0.01), including acid reflux, abdominal pain, and indigestion.

Conclusions:

• Patients with PPI-refractory NERD present with esophageal and lower esophageal sphincter motility disorders.
• Rikkunshito (RKT) demonstrated efficacy in improving esophageal motor function and symptoms in this patient group.
• Further research is warranted to investigate RKT's effects on esophageal motor activity in PPI-refractory NERD.