Efficacy and Safety of Mecobalamin Combined with Prokinetic Agents in the Treatment of Diabetic Gastroparesis: A Meta-Analysis

Background: The aim of the present study was to systematically review the efficacy and safety of mecobalamin combined with prokinetic agents in diabetic gastroparesis (DGP). Methods: A variety of databases were searched from inception to Nov 2, 2018. RCTs of mecobalamin combined with prokinetic agents group (experimental group) versus prokinetic agents only group (control group) in DGP were included. RevMan 5.3 and Stata 12.0 were used to perform the meta-analysis. Finally, 24 RCTs with 1,878 patients were included. Results: The total efficacy rate was significantly higher in the experimental group (mecobalamin combined with prokinetic drugs) compared with the control group (prokinetic drugs alone) (P<0.001), and the improvement was observed regardless of the administration route. Furthermore, the treatment group exhibited a significantly improved gastric emption rate (P<0.001), motilin (P<0.001) and recurrence rate (P<0.001), and there was no statistical difference in the incidence of adverse reactions between two groups (P=0.49). Conclusion: Mecobalamin combined with prokinetic agents can significantly improve total efficacy rate and gastric emptying rate, decrease serum motilin and the recurrence rate without increasing adverse reactions in DGP. Thus, mecobalamin may can be used as a new therapeutic option for DGP.

Functional dyspepsia and dyspepsia associated with Helicobacter pylori infection

The article presents algorithms for diagnosing and treatment of patients with H. pylori associated dyspepsia and functional dyspepsia. The importance of testing all patients with dyspepsia for H. pylori infection is emphasized, since H. pylori status has an impact on both therapy and prognosis of disease. Dyspepsia in H. pylori-positive patients is regarded as secondary, associated with H. pylori, and this cohort of patients undergoes anti-Helicopacter therapy. Dyspepsia in H. pylori-negative patients is regarded as functional dyspepsia, if there are relevant diagnostic criteria, and this cohort of patients receives treatment with antisecretory and prokinetic drugs, as well as psychopharmacological medications. Key words: Helicobacter pylori, functional dyspepsia

Need of Combining Proton Pump Inhibitors with Prokinetics: A Prospective Observational Survey Conducted in India

Background: Gastro esophageal reflux disease (GERD), a highly prevalent disorder has adverse impact on quality of life. An estimated 40% of GERD patients have incomplete response to standard PPI therapy. For these PPI refractory patients, doubling the PPI dose or switching to another PPI are pursued by the treating physicians that might not be optimal. Therefore, an appropriate second line treatment should focus on addition of gastro-prokinetic drugs that stimulates gastric motility.Materials & Methods: This was a prospective observational study conducted in 118 patients suffering from symptoms suggestive of GERD, at four centers in Indian National Capital region to assess the overlap between GERD and delayed gastric emptying and to predict the need for combination therapy of PPI with pro-kinetic drug using Frequency Scale for the Symptoms of GERD (FSSG) score.Results: The mean total FSSG score was 16.37 ± 7.50. From 118 patients, 98 (83.05%) met the criteria for GERD with FSSG total score more than eight. The mean reflux score was 7.43 ± 4.08, while the mean dysmotility score was 8.94 ± 4.83. GERD patients in this study have a high mean FSSG score, whereas dysmotility symptoms proved to be more dominant than acid reflux.Conclusion: Based on the findings of this study, combination therapy of PPI with prokinetics is recommended in subsets of patients with high FSSG scoreJ MEDICINE JUL 2018; 19 (2) : 74-78