Predictive Factors of Response to Proton Pump Inhibitors in Korean Patients With Gastroesophageal Reflux Disease

Abstract

Background/Aims Proton pump inhibitors (PPIs) are widely used in the treatment of gastroesophageal reflux disease (GERD). However, some patients fail to respond to PPI therapy. We investigated the efficacy of response to PPI therapy in patients with GERD symptoms. Methods A total of 179 subjects with GERD symptoms were prospectively enrolled and diagnosed with non-erosive reflux disease (NERD, n = 100) and erosive reflux disease (n = 79) by gastroscopy and Bernstein test and/or 24-hour esophageal pH testing. Subjects then received a standard dose of daily PPI therapy for at least 4 weeks. PPI therapy response was evaluated using questionnaires including questions about demographics, GERD symptoms, GERD impact scale, Epworth sleepiness scale, Pittsburgh sleep quality index (PSQI), hospital anxiety and depression scale, and abbreviated version of the World Health Organization quality of life scale. Results The rates of complete (≥ 80%), satisfactory (≥ 50%), partial (< 50%), and refractory response in the 179 participants were 41.3%, 30.2%, 18.4%, and 10.1%, respectively. Thus, overall response rate (complete and satisfactory responses) was 71.5%. Multivariate analysis showed body mass index < 23 kg/m 2 (OR, 2.20; 95% CI, 1.12–4.34), higher total PSQI score (OR, 1.20; 95% CI, 1.05–1.35), history of psychotherapy or neuropsychiatric medication (OR, 2.44; 95% CI, 1.23–4.85), and NERD (OR, 3.30; 95% CI, 1.54–7.11) were associated with poor response to PPI therapy. Conclusions Psychological factors, sleep dysfunction, body mass index < 23 kg/m 2 , and NERD seem to be the major factors that lead to a poor response to PPI treatment in patients with GERD symptoms.

Sex and Gender Differences in Gastroesophageal Reflux Disease

“…106 Therefore, patients with GERD are frequently treated with PPIs. 107,108 However, 17-32% of patients with GERD experienced persistent and troublesome heartburn or regurgitation despite standard-dose PPI treatment. In addition, the majority experienced refractory symptoms at higher doses.…”

“…116 However, response rates and associated factors for PPI treatment could be different according to study population and study design. 107 …”

Recurrence and Its Impact on the Health-related Quality of Life in Patients with Gastroesophageal Reflux Disease: A Prospective Follow-up Analysis

“…[4][5][6][7][8][9] However, limited data exist on the response to PPI therapy and the recurrence of GERD in East Asian countries, including Korea. [10][11][12][13] Patients with GERD have a decreased health-related quality of life (HRQoL). 12,14,15 Although HRQoL improves with treatment, persistent symptoms after PPI therapy are associated with a reduced HRQoL.…”

A Double-blind, Randomized, Multicenter Clinical Trial Investigating the Efficacy and Safety of Esomeprazole Single Therapy Versus Mosapride and Esomeprazole Combined Therapy in Patients with Esophageal Reflux Disease

“…GERD impairs the patient's quality of life (QOL) 3 and thus requires appropriate treatment; up to now, medication with protein pump inhibitors (PPIs) has been considered the best therapy. 4,5 The clinical guidelines for GERD published in Korea in 2012, 6 as well as diagnosis and treatment guidelines for GERD published in the United States in 2013, 7 indicate that PPIs are the most effective drugs for the treatment of ERD, with a high level of evidence and a strong level of recommendation. GERD is a complex multifactorial disease, which can be caused by excessive gastroesophageal reflux, reduced esophageal clearance of refluxed gastric contents, increased gastric acid, or increased sensitivity to refluxed contents in the esophageal mucosa.…”