Effects of mosapride on esophageal secondary peristalsis in humans

Background Secondary peristalsis is important for the clearance of refluxate or retained food bolus from the esophagus. Mosapride is a prokinetic agent that enhances GI motility by stimulating 5-hydroxytrypatamine(4) (5-HT4) receptors, but its effects on secondary peristalsis are yet unclear in humans. We aimed to investigate the effect of a 5-HT4 agonist mosapride on esophageal distension-induced secondary peristalsis in normal subjects. Methods After a baseline recording esophageal motility, secondary peristalsis was generated by slow and rapid mid-esophageal injections of air in 15 healthy subjects. Two separate sessions with 40 mg oral mosapride or placebo were randomly performed to test their effects on esophageal secondary peristalsis. Key Results Mosapride decreased the threshold volume for triggering secondary peristalsis during rapid air distension (4.5 +/- 0.3 vs 5.3 +/- 0.4 mL; P = 0.04) but not slow air distension (14.3 +/- 1.2 vs 13.3 +/- 1.3 mL; P = 0.41). Secondary peristalsis was triggered more frequently in response to rapid air distension after application of mosapride [100% (90-100%) vs 90% (80-100%); P = 0.02]. Mosapride significantly increased pressure wave amplitudes of secondary peristalsis during slow (135.4 +/- 13.8 vs 105.0 +/- 12.9 mmHg; P = 0.001) and rapid air distensions (124.0 +/- 11.6 vs 95.9 +/- 14.0 mmHg; P = 0.002). Conclusions & Inferences Mosapride enhances sensitivity to distension-induced secondary peristalsis and facilitates secondary peristaltic contractility. These data provide an evidence for modulation of esophageal secondary peristalsis by the 5-HT4 agonist mosapride, as well support for its clinical utility.