The enhanced recovery after surgery (ERAS) protocol includes prokinetic agents to reduce postoperative ileus. This double-blind, randomized controlled trial enrolled patients scheduled for minimally invasive gastrectomy for gastric cancer. Patients were randomly assigned to receive either mosapride citrate (control) or prucalopride succinate (experimental) from postoperative days 1 to 4. Bowel motility was assessed by tracking radiopaque marker migration on serial abdominal radiographs, along with first-flatus time, food intake, and inflammatory markers. Baseline characteristics were comparable between groups. The primary endpoint, bowel transit rate on postoperative day 3, showed no significant difference between the control (58.3%) and experimental groups (67.5%, p = 0.223). However, on postoperative day 5, the experimental group showed significantly higher colonic transit (96.9% vs. 90.2%, p = 0.012) and a greater increase in oral intake over time. The neutrophil-to-lymphocyte ratio (NLR) was significantly lower in the experimental group on POD 3 (p = 0.035). Although prucalopride succinate did not accelerate recovery of bowel motility on POD 3, it demonstrated delayed physiological improvement by POD 5 and attenuation of early inflammatory markers, without significant differences in clinical outcomes. Further research is needed to obtain confirmatory evidence before routine incorporation into ERAS protocols.

We present the case of a 66-year-old man who underwent upper gastrointestinal (GI) endoscopy and developed significant gastric residue after treatment with a long-acting glucagon-like peptide-1 receptor agonist (GLP-1RA) for type 2 diabetes. Despite prolonged fasting, large volumes of gastric residue persisted, thus impairing mucosal visualization. Instead of discontinuing GLP-1RA therapy, mosapride citrate was introduced as a gastroprokinetic agent. Three days before endoscopy, the patient received mosapride, which resulted in complete gastric clearance and optimal endoscopic visualization. This case suggests that mosapride may be an effective pre-endoscopic preparation to counteract GLP-1RA-induced delayed gastric emptying.

To observe the effect of Zhuang-medicine medicated thread moxibustion on endoplasmic reticulum stress-associated apoptotic proteins in rats with diabetic gastroparesis (DGP), so as to explore its underlying therapeutic mechanisms. Male SD rats were randomly divided into five groups:blank control, DGP model, medication, non-meridian non-acupoint (non-acupoint) moxibustion, and Yangming meridian acupoint moxibustion groups, with 12 rats in each group. The DGP model was established by intraperitoneal injection of 2% streptozotocin (STZ, 55 mg/kg). Rats of the medication group received gavage of mosapride citrate suspension (0.15 mg/mL). For rats in the Yangming meridian acupoint moxibustion group, the medicated thread moxibustion was applied to bilateral "Liangmen" (ST21), "Qichong" (ST30), "Zusanli" (ST36) and "Fenglong" (ST40), with three moxa cones for each acupoint. For rats of the non-acupoint group, the same medicated thread moxibustion was applied to the sites 2.5 mm or 5 mm away from the abovementioned Yangming meridian acupoints. The 3 intervention groups were conducted once daily for 3 weeks. The symptom scores were assessed. The blood glucose levels were measured using a blood glucose meter, and the gastric emptying rate was assessed by using phenol red gavage method. The apoptosis index of gastric smooth muscle cells was detected using TUNEL staining. The expression levels of glucose-regulated protein 78 (GRP78), activating transcription factor 6 (ATF6), and CCAAT/enhancer-binding protein homologous protein (CHOP) in the gastric antral smooth muscle were detected using Western blot, and the immunoactivities of B-cell lymphoma-2 (Bcl-2), Bcl-2-associated X protein (Bax), and Caspase-12 in the gastric smooth muscle tissues were detected using immunohistochemistry method. Compared to the control group, rats in the model group exhibited a significant increase in the symptom score, blood glucose level, smooth muscle cell apoptosis index, and the expression levels of GRP78, ATF6, CHOP, Bax and Caspase-12 proteins (P<0.01), and an obvious decrease in the gastric emptying rate and expression of Bcl-2 protein (P<0.01). In contrast to the model group, both the significant increase and decrease of the indexes mentioned above were all reversed by Yangming acupoint moxibustion and medication (P<0.01, P<0.05), but not by non-acupoint moxibustion, except blood glucose level which was only decreased in the Yangming acupoint moxibustion group (P<0.01). Comparison between the Yangming meridian acupoint group and non-acupoint group displayed that the symptom score, blood glucose, apoptosis index, and expression of GRP78, ATF6, CHOP, Bax and Caspase-12 proteins were significantly higher in the latter group than in the former group (P<0.01, P<0.05), while the gastric emptying rate and expression of Bcl-2 were significantly lower in the latter group than in the former group (P<0.01). Zhuang-medicine medicated thread moxibustion can ameliorate symptoms, promote gastric emptying and lower blood glucose in DPG rats, which may be related to its functions in regulating the expression of endoplasmic reticulum stress-associated apoptotic proteins, suppressing the expression of GRP78, ATF6, CHOP, Caspase-12, and Bax proteins (ATF6/CHOP signaling pathway) and upregulating the expression of Bcl-2 protein in the gastric antral smooth muscle.

Teaching point: The case highlights the importance of identifying gastric complications after RFCA and the need for prompt diagnosis and treatment of gastroparesis with gastrokinetic medication, such as mosapride citrate.

Background Catheter ablation has become a standard therapeutic strategy for atrial fibrillation (AF), with pulmonary vein isolation (PVI) commonly achieved using cryoballoon ablation (CBA) or radiofrequency ablation (RFA). Although CBA is associated with fewer severe complications and shorter procedural times, collateral injury to adjacent structures, such as the esophagus and periesophageal vagal plexus, can occasionally occur. Gastric hypomotility (GH) secondary to vagal nerve injury is a rare but clinically important complication that may present with nonspecific gastrointestinal symptoms. Case Presentation A 46‐year‐old woman with no history of smoking or alcohol use was diagnosed with tachycardia‐induced cardiomyopathy and heart failure due to AF. After stabilization, she underwent PVI using second‐generation CBA at another institution. Two days postprocedure, she developed abdominal pain, nausea, and upper abdominal distension. Physical examination revealed mild epigastric distension without tenderness. Laboratory findings were unremarkable except for mild elevation in blood urea nitrogen and C‐reactive protein. Abdominal radiography and CT demonstrated marked gastric dilatation without mechanical obstruction. Upper gastrointestinal endoscopy showed retained food residue in the stomach but no structural lesions. Based on these findings, postablation GH due to periesophageal vagal nerve injury was diagnosed. Treatment and Outcome Conservative outpatient management was initiated, including mosapride citrate (15 mg/day in divided doses) and a low‐fat, low‐fiber diet. The patient’s symptoms gradually improved within one month, and follow‐up imaging at three months confirmed complete resolution of gastric dilatation. No recurrence was observed during six months of follow‐up. Conclusion GH following CBA for AF is a rare but notable complication caused by vagal nerve injury. Early recognition through clinical and radiologic assessment allows effective conservative management, avoiding unnecessary invasive procedures. This case highlights the importance of multidisciplinary awareness and prompt intervention in achieving favorable outcomes.

Functional constipation (FC) is a prevalent gastrointestinal disorder that can significantly impact patients’ quality of life. In this study, we aimed to evaluate the effectiveness and safety of “abdominal tuina” and oral mosapride citrate tablets in the treatment of FC. Ninety patients with FC were randomly assigned to receive either “abdominal tuina” treatment or oral mosapride citrate tablets. Symptom scores, quality of life assessments, physiological and biochemical indicators, and mental health parameters were monitored at various time points during the 90-day treatment period. Significant improvement in clinical symptom scores was observed in the experimental group by day 10, with sustained efficacy throughout the study. The experimental group demonstrated superior effectiveness and improvements in biochemical markers and mental health scores compared to the control group. No significant adverse reactions were reported in either group. The study findings suggest that “abdominal tuina” treatment and oral mosapride citrate tablets are equally effective in managing FC, with both interventions effectively reducing symptoms and enhancing quality of life without significant adverse effects. The maintenance of treatment effects at day 10 highlights the potential benefits of these therapies for FC patients.

Data on mosapride citrate hydrate (mosapride) safety during pregnancy are limited. This study aimed to evaluate the effects of maternal mosapride exposure on pregnancy and infant outcomes. We conducted a prospective cohort study using data from two teratology information centers in Japan. Pregnant women who consulted these centers between April 1988 and December 2017 were included. The incidence of major congenital anomalies was compared between women exposed to mosapride during the first trimester and a control group. Multivariate logistic regression analysis was performed to assess potential risks. Major congenital anomalies were observed in 2 of 104 infants (1.92%) in the mosapride group and 32 of 1693 infants (1.89%) in the control group. The relative risk was 1.02 (95% confidence interval [CI] 0.24-4.26), indicating no statistically significant difference. Other pregnancy outcomes, including stillbirth, spontaneous abortion, preterm birth, and low birth weight, also showed no significant differences between groups. Although our study may not exclude small increases in risk due to sample size limitations, the findings suggest that mosapride exposure during early pregnancy is not associated with a substantial increase in the risk of major congenital anomalies. These findings may help alleviate concerns related to mosapride use during pregnancy.

Postoperative ileus is the physiologic hypomotility of the gastrointestinal tract that occurs immediately after abdominal surgery. Mosapride citrate is known to enhance gastrointestinal motility. This study aimed to evaluate mosapride's impact on postoperative ileus and gastrointestinal motility in patients undergoing elective colorectal surgery. Forty-four patients with colorectal cancer undergoing surgery at Ramathibodi Hospital between July 2021 and August 2022 were randomly assigned to either a mosapride group or a control group. The mosapride group received 5 mg of mosapride via the enteric route with 50 mL of water 3 times daily, beginning on postoperative day 1, while the control group received 5 mg of a placebo with 50 mL of water on the same schedule. A single investigator, blinded to the treatment assignments in this triple-blind study, evaluated the postoperative time to the first bowel movement and passage of flatus. Secondary outcomes included the time to step diet, length of postoperative hospital stay, and adverse effects. There were 23 patients in the control group and 21 in the mosapride group. There were no significant differences in baseline patient characteristics between the 2 groups. The mosapride group demonstrated significantly shorter times to the first bowel movement (26 hours vs. 50 hours, P=0.004) and passage of flatus (40 hours vs. 70 hours, P=0.003). Mosapride significantly improved the recovery of gastrointestinal motility and reduced the length of hospital stay without causing any serious adverse effects in patients undergoing elective colorectal surgery. Trial registration: ClinicalTrials.gov identifier: NCT04905147.

The suggested analytical technique uses sensitive spectrofluorimetric method to determine Mosapride (MS) in pure form, pharmaceutical dosage forms, and spiked human plasma. MS is selective serotonin 5-HT4 agonist that is used in treatment of gastrointestinal motility impairment. To achieve the highest sensitivity, the method was adjusted for buffer type, pH, surfactant type, concentration, diluting solvent, and time. It relies on the enhancement of MS native florescence through micelle formation with anionic surfactant sodium dodecyl sulphate SDS, which increases the native florescence by 300%. The results demonstrated that, after a 10-minute reaction, the maximum sensitivity was achieved using SDS (10 mM) in acetate buffer (PH 6). This indicates the highest RFI for MS that can be measured at 352 nm following excitation at 319 nm. With a detection limit of 14.4 ng ml-1 and a quantitation limit of 43.2 ng ml-1 for MS, the calibration curves were linear spanning the 50–2000 ng ml-1 range. The findings of the suggested analytical method's validation in accordance with ICH requirements were deemed acceptable. The suggested approach yields a high recovery rate and has been effectively used to identify the medication under study in both its pharmaceutical forms and in human plasma that has been tampered with. The greenness of the proposed method was evaluated using GABI, and AGREE methods. The precision and accuracy of the results were in great accord with the specified approach.

Postoperative ileus (POI), commonly induced by intestinal manipulation (IM) during laparotomy, results in intestinal wall injury, inflammation, adhesion, and impaired gastrointestinal motility. This study evaluated the effects of mosapride citrate (Mos), a 5-HT4 receptor agonist, and trehalose (Tre), a cytoprotective disaccharide, on gastrointestinal transit in an IM-induced POI mouse model. Mature male C57BL/6J mice were subjected to IM and allocated into five groups: IM + vehicle (control), IM + Mos (0.2 mg/kg, two times), IM + Tre (100 mg/kg, two times), IM + combined Mos & Tre, and IM + sequential Tre + Mos treatment. Gastrointestinal transit was quantified using phenol red method. All four treatment groups exhibited a significant increase in phenol red recovery in the lower small intestine compared with the control group (P<0.05). Notably, sequential administration (Tre + Mos) resulted in greater dye progression beyond the manipulated region than that of simultaneous (Mos & Tre) treatment (P<0.05). These findings suggest that although both agents individually promote gastrointestinal transit, the therapeutic effect is enhanced when Tre is administered first, followed by Mos. Thus, the timing and sequence of administration play a critical role in the treatment of POI. Sequential Tre + Mos therapy may represent a promising strategy for accelerating the functional restoration of gastrointestinal transit after intestinal injury.

The study focused on developing a sustained release matrix tablet of Mosapride Citrate to achieve prolonged therapeutic effects, reduce side effects, and improve patient compliance by minimizing dosing frequency. Mosapride Citrate, with a half-life of 2-3 hours, was used as a model drug. Matrix tablets were prepared using different viscosity grades of Eudragit through direct compression and evaluated. Results indicated that polymer matrices alone were insufficient for 8-hour sustained release, whereas a combination of Eudragit RS 100, Eudragit RL 100, and Eudragit E 100 provided effective sustained release, primarily through diffusion. The study also aimed to identify and rectify manufacturing defects. Mosapride Citrate tablets displayed good dissolution and tableting behavior. Preformulation studies evaluated physical properties like bulk and tapped density, angle of repose, compressibility, and Housner’s ratio. Tablet formulations underwent evaluations for thickness, hardness, friability, weight variation, assay, dissolution, and stability, with optimized formulations compared to marketed samples.

As a salt-type compound, mosapride citrate’s metabolism and side effects are correlated with its salt-forming ratio. Several techniques were developed in this work to compare various quantitative nuclear magnetic resonance (qNMR) methodologies and to quantitatively examine the content of raw materials. Among the qNMR techniques, methods for 1H NMR and 19F NMR were developed. Appropriate solvents were chosen, and temperature, number of scans, acquisition time, and relaxation delay parameter settings were optimized. Maleic acid was chosen as the internal standard in 1H NMR, and the respective characteristic signals of mosapride and citrate were selected as quantitative peaks. The internal standard in 19F NMR analysis was 4,4′-difluoro diphenylmethanone, and the distinctive signal peak at −116.15 ppm was utilized to quantify mosapride citrate. The precision, repeatability, linearity, stability, accuracy, and robustness of the qNMR methods were all validated according to the ICH guidelines. By contrasting the outcomes with those from high-performance liquid chromatography (HPLC), the accuracy of qNMR was assessed. As a result, we created a quicker and easier qNMR approach to measure the amount of mosapride citrate and evaluated several qNMR techniques to establish a foundation for choosing quantitative peaks for the qNMR method. Concurrently, it is anticipated that various selections of distinct quantitative objects will yield the mosapride citrate salt-forming ratio.

Effect of thumbtack needle on functional constipation: A pragmatic randomized controlled trial

The enhanced recovery after surgery (ERAS) protocol, including prokinetic medications, is commonly used to prevent postoperative ileus. Prospective studies evaluating the effectiveness of mosapride citrate, a prokinetic 5-hydroxytryptamine 4 receptor agonist, in patients undergoing gastrectomy within the ERAS framework are lacking. This double-blind randomized trial included patients who were scheduled for laparoscopic or robotic gastrectomy for gastric cancer. Participants were randomly assigned to either a control (placebo) or experimental (mosapride citrate) group, with drugs administered on postoperative days 1–5. Bowel motility was evaluated based on bowel transit time measured using radiopaque markers, first-flatus time, and amount of food intake. No significant differences were observed in baseline characteristics between the two groups. On postoperative day 3, no significant difference was observed in the number of radiopaque markers visible in the colon between the groups. All factors associated with bowel recovery, including the time of first flatus, length of hospital stay, amount of food intake, and severity of abdominal discomfort, were similar between the two groups. Mosapride citrate does not benefit the recovery of intestinal motility after minimally invasive gastrectomy in patients with gastric cancer. Therefore, routine postoperative use of mosapride citrate is not recommended in such patients.

Integration of sustainable chemistry frameworks with a single-pot, on-off fluorescence approach for enabling the facile quantification of mosapride; Application to pharmaceutical tablets and content uniformity

Constipation-predominant irritable bowel syndrome (IBS-C) is a functional bowel disease that affects 10-20% of the population worldwide. Curcumin (CUR) is widely used in traditional Chinese medicine to treat IBS, but its mechanism of action needs further investigation. In this study, we used mosapride (MOS) as a positive control to evaluate the changes in gut microbiota in IBS-C rat models after treatment with CUR or MOS by analyzing 16S rDNA variation. In addition, we used enzyme immunoassay kits and immunohistochemical analysis to investigate whether CUR or MOS influenced serotonin (5-HT), substance P (SP), and vasoactive intestinal peptide (VIP) levels in the serum and colon of IBS-C rats. The study showed that rats supplemented with CUR showed significantly increased fecal weight, fecal water content, small intestine transit rate and significantly decreased serum levels of 5-HT, VIP and SP compared to the IBS group (p < 0.05). In addition, treatment with CUR changed the relative abundance of Blautia, Sutterella, Acetanaerobacterium and Ruminococcus2 in the gut microbiota. This study showed that the efficacy of CUR on IBS-C was possibly by modulating the microbiota and lowering the serum levels of HT, SP, and VIP.

AimTo analyze the efficacy and safety of Bifidobacterium quadruple viable tablets combined with mosapride citrate for the treatment of constipation.MethodsA systematic review was performed on studies published until July 2022 in PubMed, Embase, China National Knowledge Infrastructure, and Wanfang. The efficacy rate, adverse reaction rate, recurrence rate, and clinical symptoms were included in the measured outcomes.ResultsThe efficacy of Bifidobacterium quadruple viable tablets combined with mosapride citrate in the treatment of constipation was higher than that of mosapride citrate alone (OR = 4.75, 95% CI (3.27, 6.90), Z = 8.19, P < 0.001; I2 = 0.0%, P = 0.645). There was no significant difference in the incidence of adverse reactions between the two groups (OR = 0.97, 95% CI (0.61,1.57), Z = 0.11, P = 0.911; I2 = 0.0%, P = 0.958). The recurrence rate of constipation in patients receiving the combination treatment was lower than that of patients treated with mosapride citrate alone (OR = 0.48, 95%CI (0.31, 0.73), Z = 3.38, P = 0.001; I2 = 29.8%, P = 0.200).ConclusionsBifidobacterium quadruple viable tablets combined with mosapride citrate demonstrated efficacy and safety in treating constipation. Probiotics have the potential to positively influence gut health and microbial profiles in patients with functional constipation.

Mosapride citrate (MC) is a poorly soluble short half-life drug with more pronounced absorption in the stomach. The present study aimed to incorporate MC co-crystals with enhanced solubility into 3D-printed floating tablets. MC co-crystals were prepared via the green method using Saccharin sod. as a co-former at a (1:1) molar ratio. The prepared co-crystals were assessed for solubility, FTIR, thermal behavior, and SEM. Then, it was incorporated into zero % infill 3D-printed tablets of different configurations at two thickness levels by the FDM printing technique. Printed tablets were evaluated for dimensions, weight deviation, friability, and in vitro floating behavior. Drug release and kinetic of the MC release were also assessed. Solubility study of the co-crystals showed a significant (p value < 0.05) increased solubility over pure MC. FTIR and thermal behavior confirmed hydrogen bonding formation during co-crystallization. The obstructed particles had an erratic protrusion form, similar to a nodule, as illustrated by SEM. The printed tablets showed acceptable physicochemical properties. Tablets floated for about ≥ 12 h without floating lag time. In vitro drug release exhibited variable extended release profiles with different lag times depending on the configuration indicating that the tablet’s wall thickness and surface area were the factors manipulated to control drug release. Kinetic analysis of the release data displayed intermediate kinetics between zero-order and diffusional kinetics. The intragastric extended release profile for MC co-crystals of improved solubility could be successfully, economically, and quickly developed utilizing the 3D printing technique.Graphical

Bowls-unblocking and mind-regulating acupuncture therapy for constipation-predominant irritable bowel syndrome: An exploratory randomized clinical trial 通腑调神针法治疗便秘型肠易激综合征:随机对照试验

Effect of Massa Medicata Fermentata on the intestinal flora of rats with functional dyspepsia.