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Concomitant irritable bowel syndrome is associated with failure of step-down on-demand proton pump inhibitor treatment in patients with gastro-esophageal reflux disease.
Neurogastroenterol Motil. 2011 Feb; 23(2):155-60, e31.NM

Abstract

BACKGROUND

The predictors for treatment failure of on-demand proton pump inhibitor (PPI) therapy in gastro-esophageal reflux disease (GERD) patients are unclear. We studied the efficacy and predictors for treatment failure of step-down on-demand PPI therapy in patients with non-erosive reflux disease (NERD) and those with low grade erosive esophagitis.

METHODS

Consecutive symptomatic GERD patients who had positive esophageal pH studies and complete symptom resolution with initial treatment of esomeprazole were given step-down on-demand esomeprazole for 26 weeks. Patients with esophagitis of Los Angeles (LA) grade C or above and recent use of PPI were excluded. Treatment failure was defined as an inadequate relief of reflux symptoms using global symptom assessment. Potential predictors of treatment failure were determined using multivariate analysis.

KEY RESULTS

One hundred and sixty three NERD and 102 esophagitis patients were studied. The 26-week probability of treatment failure was 36.2% (95% CI: 23.9-46.5%) in NERD group and 20.1% (95% CI: 10.9-28.3%) in esophagitis group, respectively (P = 0.021). Irritable bowel syndrome (adjusted HR: 2.1, 95% CI: 1.5-3.8, P = 0.01), in addition to daily reflux symptom (adjusted hazard ratio: 2.7, 95% CI: 1.9-4.2, P = 0.001) and concomitant dyspepsia (adjusted hazard ratio: 1.7, 95% CI: 1.1-2.8, P = 0.04), were independent predictors for treatment failure.

CONCLUSIONS & INFERENCES

Compared to patients with esophagitis, NERD patients have higher failure rate of on-demand PPI therapy. Concomitant irritable bowel syndrome, in addition to daily reflux symptom and dyspepsia, is associated with the failure of on-demand PPI in these patients.

Authors+Show Affiliations

Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong. justinwu@cuhk.edu.hkNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21087355

Citation

Wu, J C Y., et al. "Concomitant Irritable Bowel Syndrome Is Associated With Failure of Step-down On-demand Proton Pump Inhibitor Treatment in Patients With Gastro-esophageal Reflux Disease." Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society, vol. 23, no. 2, 2011, pp. 155-60, e31.
Wu JC, Lai LH, Chow DK, et al. Concomitant irritable bowel syndrome is associated with failure of step-down on-demand proton pump inhibitor treatment in patients with gastro-esophageal reflux disease. Neurogastroenterol Motil. 2011;23(2):155-60, e31.
Wu, J. C., Lai, L. H., Chow, D. K., Wong, G. L., Sung, J. J., & Chan, F. K. (2011). Concomitant irritable bowel syndrome is associated with failure of step-down on-demand proton pump inhibitor treatment in patients with gastro-esophageal reflux disease. Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society, 23(2), 155-60, e31. https://doi.org/10.1111/j.1365-2982.2010.01627.x
Wu JC, et al. Concomitant Irritable Bowel Syndrome Is Associated With Failure of Step-down On-demand Proton Pump Inhibitor Treatment in Patients With Gastro-esophageal Reflux Disease. Neurogastroenterol Motil. 2011;23(2):155-60, e31. PubMed PMID: 21087355.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Concomitant irritable bowel syndrome is associated with failure of step-down on-demand proton pump inhibitor treatment in patients with gastro-esophageal reflux disease. AU - Wu,J C Y, AU - Lai,L H, AU - Chow,D K L, AU - Wong,G L H, AU - Sung,J J Y, AU - Chan,F K L, Y1 - 2010/11/19/ PY - 2010/11/20/entrez PY - 2010/11/23/pubmed PY - 2011/6/18/medline SP - 155-60, e31 JF - Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society JO - Neurogastroenterol. Motil. VL - 23 IS - 2 N2 - BACKGROUND: The predictors for treatment failure of on-demand proton pump inhibitor (PPI) therapy in gastro-esophageal reflux disease (GERD) patients are unclear. We studied the efficacy and predictors for treatment failure of step-down on-demand PPI therapy in patients with non-erosive reflux disease (NERD) and those with low grade erosive esophagitis. METHODS: Consecutive symptomatic GERD patients who had positive esophageal pH studies and complete symptom resolution with initial treatment of esomeprazole were given step-down on-demand esomeprazole for 26 weeks. Patients with esophagitis of Los Angeles (LA) grade C or above and recent use of PPI were excluded. Treatment failure was defined as an inadequate relief of reflux symptoms using global symptom assessment. Potential predictors of treatment failure were determined using multivariate analysis. KEY RESULTS: One hundred and sixty three NERD and 102 esophagitis patients were studied. The 26-week probability of treatment failure was 36.2% (95% CI: 23.9-46.5%) in NERD group and 20.1% (95% CI: 10.9-28.3%) in esophagitis group, respectively (P = 0.021). Irritable bowel syndrome (adjusted HR: 2.1, 95% CI: 1.5-3.8, P = 0.01), in addition to daily reflux symptom (adjusted hazard ratio: 2.7, 95% CI: 1.9-4.2, P = 0.001) and concomitant dyspepsia (adjusted hazard ratio: 1.7, 95% CI: 1.1-2.8, P = 0.04), were independent predictors for treatment failure. CONCLUSIONS & INFERENCES: Compared to patients with esophagitis, NERD patients have higher failure rate of on-demand PPI therapy. Concomitant irritable bowel syndrome, in addition to daily reflux symptom and dyspepsia, is associated with the failure of on-demand PPI in these patients. SN - 1365-2982 UR - https://www.unboundmedicine.com/medline/citation/21087355/Concomitant_irritable_bowel_syndrome_is_associated_with_failure_of_step_down_on_demand_proton_pump_inhibitor_treatment_in_patients_with_gastro_esophageal_reflux_disease_ L2 - https://doi.org/10.1111/j.1365-2982.2010.01627.x DB - PRIME DP - Unbound Medicine ER -