Clinical Characteristics of Patients with Gastroesophageal Reflux Disease Refractory to Proton Pump Inhibitors and the Effects of Switching to 20 mg Esomeprazole on Reflux Symptoms and Quality of Life

Abstract

BackgroundRefractory gastroesophageal reflux disease (GERD) may deteriorate patient quality of life (QOL) despite proton pump inhibitor (PPI) therapy.Material/MethodsNineteen Japanese institutions were surveyed to determine the clinical characteristics and QOL of patients with refractory GERD. Those patients treated with a conventional PPI were switched to 20 mg esomeprazole for 4 weeks. Symptoms and QOL were assessed using Global Overall Symptom and Gastrointestinal Symptom Rating Scale (GSRS) questionnaires at baseline and at 2 and/or 4 weeks of esomeprazole treatment.ResultsOf 120 patients who completed the survey, 58 (48.3%) had refractory GERD. Of these, 69.0% were aged ≥65 years, 79.3% were prescribed a PPI at a standard or high dose, and 22.4% were prescribed a PPI together with another drug. After switching to esomeprazole, patients reported significant improvements in heartburn, acid regurgitation, and excessive belching at 2 weeks using a symptom diary, as well as the total score, reflux, abdominal pain, and indigestion, which were assessed using the GSRS at 4 weeks.ConclusionsAbout half of Japanese patients with GERD may be refractory to conventional PPIs. Their reflux-related symptoms are often severe and may impair QOL. Switching to esomeprazole could be used to improve their symptoms and QOL.

Prevalence of Gastroesophageal Reflux Disease and Proton Pump Inhibitor-Refractory Symptoms

“…42,43 The increased prevalence of functional and psychosomatic disorders among women may account in part for their increased odds of persistent GERD symptoms while on PPIs, as seen in our study. 43 With regard to age, a Japanese study found that older age was more associated with PPI-resistance, 44 which is contrary to our findings. The higher prevalence of PPIrefractory GERD symptoms among younger individuals in our population may again be explained by the higher prevalence of somatization and functional disorders among this group, 43 where PPIs are unlikely to improve esophageal symptoms.…”

Esophageal Body Motility for Clinical Assessment in Patients with Refractory Gastroesophageal Reflux Symptoms

“…Previous studies had revealed that RGERD was more strongly related with weakly acid reflux and alkaline reflux than acid reflux. 6,24,38,39 Furthermore, long term usage of PPI might reduce the detective acid reflux episodes difference between the 2 groups. In addition, only 48 patients were enrolled in our study, and the small sample size might be related with the results.…”

Thailand guideline 2020 for medical management of gastroesophageal reflux disease

“…Another clustered randomization trial conducted in Canada indicated that switching the PPI to esomeprazole would result in a mean 0.071 (95% CI 0.091–0.051, P < 0.0001) gain in quality‐adjusted life months compared with continuing with another PPI (other than esomeprazole and lansoprazole) or H2RA therapy 72 . Another small uncontrolled study from Japan also suggested that switching PPI would improve reflux symptom 73 …”