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Partial symptom‐response to proton pump inhibitors in patients with non‐erosive reflux disease or reflux oesophagitis – a post hoc analysis of 5796 patients
Author(s) -
Bytzer P.,
Zanten S. Veldhuyzen,
Mattsson H.,
Wernersson B.
Publication year - 2012
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.12007
Subject(s) - heartburn , medicine , reflux , esomeprazole , gastroenterology , omeprazole , gerd , proton pump inhibitor , reflux esophagitis , pantoprazole , esophagitis , esophageal disease , disease , esophagus
Summary Background Although most patients with gastro‐oesophageal reflux disease ( GERD ) benefit from proton pump inhibitor ( PPI ) therapy, some experience only partial symptom relief. Aim To determine the prevalence of partial heartburn response to PPI s and its impact on health‐related quality of life. Methods Four randomised, double‐blind studies in adults with reflux disease compared esomeprazole 40 mg/day or 20 mg/day with omeprazole 20 mg/day, or esomeprazole 40 mg/day with pantoprazole 40 mg/day. Patients with heartburn on ≥4 days during the 1‐week recall period at baseline were included. Partial response was defined as heartburn on ≥3 days during the last treatment week and reduced heartburn frequency after 4 weeks of treatment compared with baseline. Results The analysis included 2645 patients with non‐erosive reflux disease (mean age: 48.8 years; 54.4% women) and 3151 patients with reflux oesophagitis (mean age: 50.6 years; 37.1% women). At baseline, most patients reported heartburn on 5–7 days (non‐erosive reflux disease: 82.2%; reflux oesophagitis: 86.8%). Partial heartburn response occurred in 19.9% of patients with non‐erosive reflux disease and 14.0% with reflux oesophagitis. Defining partial response as heartburn on ≥2 days increased these rates to 26.2% and 19.3%, respectively; defining partial response as heartburn of moderate or severe intensity on ≥3 days decreased these rates to 6.4% and 5.3%, respectively. Nonresponse to PPI s was rare (non‐erosive reflux disease: 2.4%; reflux oesophagitis: 1.4%). Conclusion Using our conservative definition, partial heartburn response to proton pump inhibitor therapy occurred in 14–20% of gastro‐oesophageal reflux disease patients, more commonly in non‐erosive reflux disease than in reflux oesophagitis.