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Treatment Option for Patients with Non-Erosive Gastroesophageal Reflux Disease Refractory to a Standard Proton Pump Inhibitor (GJGH v2n2a4) - synergy - synergy

Treatment Option for Patients with Non-Erosive Gastroesophageal Reflux Disease Refractory to a Standard Proton Pump Inhibitor Pages 59-68

Mitsushige Sugimoto1, Masafumi Nishino1, Chise Kodaira1, Mihoko Yamade1, Takahiro Uotani1 and Takahisa Furuta2

1First Department of Medicine, and 2Center for Clinical Research, Hamamatsu University School of Medicine, Shizuoka, Japan

http://dx.doi.org/10.12970/2308-6483.2014.02.02.4

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Abstract: Background: Non-erosive gastroesophageal reflux disease (NERD) resists treatment with standard proton pump inhibitor (PPI) doses in about 50% of patients. However, physicians do not have clear choices available for selecting alternative treatments for the refractory patients. Therefore, we investigated the effectiveness of double-dose PPI or a 5-hydroxytryptamine receptor antagonist (5HTRA) given with the standard PPI dose.

Methods: We treated 10 NERD patients resistant to 10mg rabeprazole (RPZ) [RPZ(10)] with 20 mg od RPZ [RPZ(20)] or 10 mg od RPZ plus 5 mg tid mosapride (RPZ-MOS) for 14-days in a cross-over manner. All patients’ pHs were monitored for 24 h and they were given a “Frequency Scale for the Symptoms of GERD” (FSSG) questionnaire to document their NERD symptoms, both on day 14.

Results: The median FSSG score was significantly lowered by RPZ-MOS [7.0 (4-16), p < 0.01] and RPZ (20) [10.5 (1-28), p < 0.01] regimens compared with that for RPZ (10) [13.5 (10-31)]. However, FSSG scores were not significantly different between both regimens. The FSSG score was significantly associated with intragastric pH (p = 0.02). The RPZ-MOS regimen’s FSSG score was significantly correlated with RPZ (20) treatment (p = 0.02). The FSSG scores of RPZ (10) in patients responsive to both regimens improved ≥ 30% compared with control scores.

Conclusions: NERD patients whose FSSG score failed to decrease ≥ 30% after RPZ 10 mg od treatment would be refractory to additional PPI or 5HTRA doses. FSSG scores after RPZ 10 mg od treatment may provide a guideline for optimally treating NERD patients with a PPI.

Keywords: NERD, rabeprazole, mosapride, CYP2C19, proton pump inhibitor. Read more →

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