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01-11-2011 | Original Article—Alimentary Tract

Investigation of pretreatment prediction of proton pump inhibitor (PPI)-resistant patients with gastroesophageal reflux disease and the dose escalation challenge of PPIs—TORNADO study: a multicenter prospective study by the Acid-Related Symptom Research Group in Japan

Authors: Takahisa Furuta, Tomohiko Shimatani, Mitsushige Sugimoto, Shunji Ishihara, Yasuhiro Fujiwara, Motoyasu Kusano, Tomoyuki Koike, Michio Hongo, Tsutomu Chiba, Yoshikazu Kinoshita, The Acid-Related Symptom Research Group

Published in: Journal of Gastroenterology | Issue 11/2011

Abstract

Backgrounds

Some non-erosive reflux disease (NERD) and reflux esophagitis (RE) patients are unresponsive to a proton pump inhibitor (PPI) at standard dose. We investigated the predictive marker of the efficacy of PPI for GERD patients including NERD and RE treated with standard and increased doses of a PPI.

Methods

Patients with symptomatic gastroesophageal reflux disease (GERD) (NERD and RE) were treated with rabeprazole (RPZ) 10 mg once daily for 4 weeks. The RPZ dosage was increased to 10 mg twice daily for an additional 2 weeks and again to 20 mg twice daily for another 2 weeks if heartburn was not relieved. Baseline characteristics and efficacy of RPZ were assessed on the basis of a heartburn diary and frequency scale for symptoms of GERD (FSSG).

Results

Complete heartburn relief rates after 4 weeks were 42.5% (31/73) and 67.9% (19/28) in NERD and RE groups, respectively, which rose to 68.9 and 91.7% after dose escalation. Multivariate analysis revealed that parameters associated with resistance to RPZ 10 mg once daily were female, non-smoking, frequent heartburn, low score for question 4 (Q4) of the FSSG (subconsciously rubbing the chest), and high scores for Q3 (heavy stomach after meal) and Q7 (unusual sensation in the throat). Frequent heartburn and a high score for Q7 were associated with resistance to RPZ 20 mg twice daily. FSSG scores of patients resistant to RPZ were significantly higher in comparison with responders before and during treatment.

Conclusions

FSSG could predict response to a PPI for symptomatic GERD. Increase of RPZ dose is useful for treatment of GERD refractory to the standard dose of RPZ.

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Title: Investigation of pretreatment prediction of proton pump inhibitor (PPI)-resistant patients with gastroesophageal reflux disease and the dose escalation challenge of PPIs—TORNADO study: a multicenter prospective study by the Acid-Related Symptom Research Group in Japan
Authors: Takahisa Furuta
Tomohiko Shimatani
Mitsushige Sugimoto
Shunji Ishihara
Yasuhiro Fujiwara
Motoyasu Kusano
Tomoyuki Koike
Michio Hongo
Tsutomu Chiba
Yoshikazu Kinoshita
The Acid-Related Symptom Research Group
Publication date: 01-11-2011
Publisher: Springer Japan
Published in: Journal of Gastroenterology / Issue 11/2011
Print ISSN: 0944-1174
Electronic ISSN: 1435-5922
DOI: https://doi.org/10.1007/s00535-011-0446-2

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Abstract

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