Gastroesophageal reflux disease (GERD) affects a substantial portion of the population, with symptoms often persisting despite standard proton pump inhibitor (PPI) therapy. In many cases, these persistent symptoms are linked not to acid reflux but to non-acid or weakly acidic reflux episodes, which are not adequately detected by traditional pH monitoring alone. This presents a diagnostic and therapeutic challenge, particularly in patients who remain symptomatic despite optimal PPI use. The case series presented here evaluates the impact of prucalopride—a selective 5-HT4 receptor agonist—on refractory GERD symptoms in four chronically constipated female patients with documented non-acid reflux confirmed via combined multichannel impedance and pH monitoring.
All patients had a history of chronic constipation and long-standing GERD symptoms, including heartburn, regurgitation, bloating, and globus sensation, that persisted despite at least four weeks of standard PPI therapy and, in some cases, additional H2-receptor antagonist use. Initial ambulatory MII-pH monitoring revealed elevated total reflux episodes, with a majority classified as non-acidic or weakly acidic. Symptom association indices were positive for heartburn and regurgitation in three patients, indicating a clear link between reflux events and symptom occurrence. Subjective symptom scores ranged from 5 to 9 on a 10-point scale, reflecting moderate to severe symptom burden affecting daily functioning.
Following initiation of prucalopride at 2 mg once daily, all patients underwent repeat MII-pH monitoring after four to six weeks. The results demonstrated a significant reduction in overall reflux episodes across all participants. Notably, non-acid reflux episodes decreased substantially in every patient, with one showing a drop from 128 to 76 episodes. Acid reflux episodes showed variable changes—some increased slightly, likely due to physiological variability in monitoring, while others declined significantly. Despite minor fluctuations in acid exposure, the overall trend indicated improved control of reflux activity. Most importantly, subjective reports aligned with objective findings: patients reported fewer symptom occurrences, reduced intensity, and improved quality of life. For example, one patient’s symptom score dropped from 7 to 3, and another noted marked relief in bloating and throat discomfort.SOS1 ProteinSynonyms
No major adverse effects were observed during treatment.Triciribine Epigenetics Patients experienced mild gastrointestinal side effects such as transient diarrhea or abdominal cramping, which resolved spontaneously without discontinuation.PMID:35076747 These findings suggest that prucalopride is well tolerated in this population. The mechanism behind its efficacy may involve enhanced gastric emptying and intestinal transit, which reduces reflux burden by minimizing gastric content volume and improving clearance. Additionally, potential effects on esophageal motility—such as increased lower esophageal sphincter pressure and reduced transient relaxations—may contribute to symptom improvement, although further high-resolution manometry studies are needed to confirm this.
This case series provides early but compelling evidence that prucalopride can effectively reduce both non-acid and total reflux episodes in PPI-resistant GERD patients with chronic constipation. Its dual action on colonic and upper GI motility makes it uniquely suited for this patient subgroup. While larger, randomized controlled trials are necessary to validate these results, the data support prucalopride as a promising therapeutic option for patients with refractory GERD who fail conventional treatments. Future research should explore its role in non-constipated GERD populations and investigate long-term safety and efficacy.MedChemExpress (MCE) offers a wide range of high-quality research chemicals and biochemicals (novel life-science reagents, reference compounds and natural compounds) for scientific use. We have professionally experienced and friendly staff to meet your needs. We are a competent and trustworthy partner for your research and scientific projects.Related websites: https://www.medchemexpress.com