Treatment Option for Patients with Non-Erosive Gastroesophageal Reflux Disease Refractory to a Standard Proton Pump Inhibitor
Authors
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
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.
