Need of Combining Proton Pump Inhibitors with Prokinetics: A Prospective Observational Survey Conducted in India

Abstract

Background: Gastro esophageal reflux disease (GERD), a highly prevalent disorder has adverse impact on quality of life. An estimated 40% of GERD patients have incomplete response to standard PPI therapy. For these PPI refractory patients, doubling the PPI dose or switching to another PPI are pursued by the treating physicians that might not be optimal. Therefore, an appropriate second line treatment should focus on addition of gastro-prokinetic drugs that stimulates gastric motility.Materials & Methods: This was a prospective observational study conducted in 118 patients suffering from symptoms suggestive of GERD, at four centers in Indian National Capital region to assess the overlap between GERD and delayed gastric emptying and to predict the need for combination therapy of PPI with pro-kinetic drug using Frequency Scale for the Symptoms of GERD (FSSG) score.Results: The mean total FSSG score was 16.37 ± 7.50. From 118 patients, 98 (83.05%) met the criteria for GERD with FSSG total score more than eight. The mean reflux score was 7.43 ± 4.08, while the mean dysmotility score was 8.94 ± 4.83. GERD patients in this study have a high mean FSSG score, whereas dysmotility symptoms proved to be more dominant than acid reflux.Conclusion: Based on the findings of this study, combination therapy of PPI with prokinetics is recommended in subsets of patients with high FSSG scoreJ MEDICINE JUL 2018; 19 (2) : 74-78

The rabbit as a surgical model for early training stages of the laparoscopic Nissen fundoplication technique

“…Proton pump inhibitors are the mainstay for treatment of acid disorders such as GERD in humans. 25 However, Nissen fundoplication is the gold standard for GERD treatment in patients that require antireflux surgery: 1) patients with symptoms who respond inadequately to proton-pump inhibitors (PPI); 2) patients that continue to have nonacid reflux, even eliminating heartburn by PPI; 3) patients with symptoms such as chest pain, cough, or wheezing, who have well-documented reflux events; 4) patients with secondary peptic stricture, Barrett's esophagus, or vocal cord injuries; and 5) patients with well-documented GERD, who wish to stop the chronic use of a PPI. 26 In humans, Nissen fundoplication can be performed laparoscopically with five access ports, two of which are 10 mm in length and three that have a 5 mm span.…”