Onset of symptom relief with rabeprazole: a community‐based, open‐label assessment of patients with erosive oesophagitis

Abstract

Background: In numerous clinical trials, proton pump inhibitors have demonstrated potent acid suppression and healing of erosive oesophagitis, as well as successful symptom relief for the entire spectrum of gastro‐oesophageal reflux disease. Aim: The `Future of Acid Suppression Therapy' (FAST) trial evaluated, in actual clinical practice, the timing of symptom relief, changes in symptom severity, health‐related quality of life and safety in endoscopically confirmed erosive gastro‐oesophageal reflux disease treated with rabeprazole. Methods: This open‐label, multicentre study enrolled 2579 patients to receive rabeprazole treatment using 20 mg once daily for 8 weeks. Between two clinical visits (at enrolment and week 8), patients used an interactive voice response system to rate gastro‐oesophageal reflux disease symptoms. Subgroup analyses of efficacy were conducted for gender, age, Hetzel–Dent grade, presence of Barrett's oesophagus and for patients reporting previously ineffective symptom relief with omeprazole or lansoprazole. Results: On day 1, rabeprazole significantly decreased daytime and night‐time heartburn severity, regurgitation and belching. Complete relief of daytime and night‐time heartburn was achieved in 64.0% and 69.2% of symptomatic patients, respectively, on day 1, and in 81.1% and 85.7% of patients, respectively, on day 7. Patients with moderate or severe heartburn symptoms at baseline achieved an even greater degree of satisfactory symptom relief (none or mild) from day 1 onwards. The median time to satisfactory heartburn relief was 2 days. Subgroup analyses showed no consistent differences in efficacy compared to the overall population treated. Health‐related quality of life in patients was significantly lower than that of the US general population and improved significantly after 8 weeks of rabeprazole therapy. Rabeprazole was well tolerated, with headache as the most common adverse event, reported by less than 2% of the study population. Conclusions: In this large, open‐label trial, rabeprazole rapidly and effectively relieved gastro‐oesophageal reflux disease symptoms in most patients with erosive oesophagitis. Substantial symptom relief was noted on day 1; improvement continued over the first week and at week 4. By week 8, the health‐related quality of life had also improved vs. baseline.

Lifestyle Factors and Efficacy of Lifestyle Interventions in Gastroesophageal Reflux Disease Patients with Functional Dyspepsia: Primary Care Perspectives from the LEGEND Study

“…The most effective treatment for GERD is recognized to be a PPI; however, a significant proportion of patients experi- ence persistent symptoms or exhibit endoscopic evidence of esophagitis despite the use of PPIs. In addition, approximately 10% to 20% of patients with GERD fail to respond symptomatically, either partially or completely, to standarddose PPI therapy (8)(9)(10). Options for patients with PPIresistant or refractory GERD include doubling the PPI dose or adding an H2-receptor antagonist, antacids or prokinetics, although these treatment options are not cost effective and several studies have indicated the potential for adverse events following short-and long-term acid suppression (11)(12)(13).…”

Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015

“…(1) Symptoms of GERD and HR-QOL Either by medical treatment or surgical treatment, QOL of GERD patients improves after complete control of GERD symptoms [40][41][42]. When GERD symptoms disappear, QOL of GERD patients improves to a level equal to or above that of healthy subjects [4].…”

Therapeutic Options in the Treatment of Nighttime Gastroesophageal Reflux

“…The efficacy of PPI therapy in the treatment of nighttime GERD symptoms has been well documented [27,28,29,30,31,32]. It should be noted that direct comparisons from study to study with regard to the comparative efficacy of PPI drugs in specifically treating nighttime reflux may be difficult due to major differences in how nighttime reflux is defined and how the data are presented.…”