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Background  Approximately, 20–30% of patients with gastro‐esophageal reflux disease ( GERD ) experience persistent symptoms despite treatment with proton pump inhibitors ( PPI s). These patients may have underlying dysmotility; therefore, targeting gastric motor dysfunction in addition to acid inhibition may represent a new therapeutic avenue. The aim of this study was to assess the pharmacodynamic effect of the prokinetic agent revexepride (a 5‐ HT  4  receptor agonist) in patients with  GERD  who have persistent symptoms despite treatment with a  PPI .    Methods  This was a phase II, exploratory, multicenter, randomized, placebo‐controlled, double‐blind, parallel‐group study in patients with  GERD  who experienced persistent symptoms while taking a stable dose of  PPI s ( ClinicalTrials.gov  identifier: NCT01370863). Patients were randomized to either revexepride (0.5 mg, three times daily) or matching placebo for 4 weeks. Reflux events and associated characteristics were assessed by pH/impedance monitoring and disease symptoms were assessed using electronic diaries and questionnaires.    Key Results  In total, 67 patients were enrolled in the study. There were no significant differences between study arms in the number, the mean proximal extent or the bolus clearance times of liquid‐containing reflux events. Changes from baseline in the number of heartburn, regurgitation, and other symptom events were minimal for each treatment group and no clear trends were observed.    Conclusions & Inferences  No clear differences were seen in reflux parameters between the placebo and revexepride groups.

neurogastroenterology and motility

Randomized clinical trial: effect of the 5‐ HT  4  receptor agonist revexepride on reflux parameters in patients with persistent reflux symptoms despite  PPI  treatment