Evaluating the efficacy and safety of acotiamide in patients with esophagogastric junction outflow obstruction: study protocol for an investigator-initiated, multi-center, randomized, double-blind, placebo-controlled phase II trial

Article summaryStrengths and limitations of this studyThis is the first prospective and randomized controlled trial to investigate the superiority of acotiamide over a placebo in the treatment of patients with EGJOO.The trial provides evidence that acotiamide can be used as a treatment for patients with EGJOO.Long-term outcomes cannot be assessed because this trial focuses on the short-term outcomes of acotiamide for the treatment of patients with EGJOO. BackgroundWe have determined that the impaired accommodation of the lower esophageal sphincter (LES) underlies the pathogenesis of esophagogastric junction outflow obstruction (EGJOO). We have also found that acotiamide may treat EGJOO by improving impaired LES accommodation. The effects of acotiamide in patients with EGJOO need to be further confirmed in a prospective study.MethodsThis trial is a multicenter, randomized, double-blind, placebo-controlled study to compare the efficacy and safety of acotiamide (300 mg/day or 600 mg/day) with those of a placebo in the treatment of patients with EGJOO. The primary endpoint will be the proportion of patients who report an improvement in symptom of food sticking in the chest after 4 weeks of treatment period 1. The secondary endpoints will be the proportion of patients with normalized integrated relaxation pressure (IRP), the value of change from baseline in the distal contractile integral, basal LES pressure, EGJOO-quality of life score, Gastrointestinal Symptom Rating Scale, and the correlation between IRP and each symptom score. During the 2-year trial period, 42 patients from five institutions will be enrolled.DiscussionThis trial will provide evidence to clarify the efficacy and safety of acotiamide as a treatment for patients with EGJOO. Acotiamide might help improve the quality of life of patients with EGJOO and is expected to prevent the progression of EGJOO to achalasia.

Automated summary

This study is the first prospective and randomized controlled trial to investigate the superiority of acotiamide over a placebo in the treatment of patients with EGJOO. The trial provides evidence that acotiamide can be used as a treatment for patients with EGJOO. Long-term outcomes cannot be assessed because this trial focuses on the short-term outcomes of acotiamide for the treatment of patients with EGJOO.