The daily response for proton pump inhibitor treatment in Japanese reflux esophagitis and non-erosive reflux disease

Abstract

We investigated comparison according to reflux esophagitis and non-erosive reflux disease about "daily" symptom improvement for proton pump inhibitor treatment. We enrolled 57 reflux esophagitis and 90 non-erosive reflux disease patients. They took rabeprazole 10 mg/day for 28 days and completed "daily" in the Frequency Scale for the Symptoms of GERD from baseline until day 14, and after 28 days of treatment. The efficacy endpoint was the improvement rates in Frequency Scale for the Symptoms of GERD, based on baseline. Frequency Scale for the Symptoms of GERD was decreased in reflux esophagitis and non-erosive reflux disease (p<0.001) and was significantly lower in reflux esophagitis than in non-erosive reflux disease from the first day of treatment (p<0.05). Symptomatic improvement rates were also significantly higher in reflux esophagitis (50.3 ± 44.9%) than in non-erosive reflux disease (31.7 ± 43.2%) from the first day of treatment (p<0.0001). The symptomatic improvement rates in reflux esophagitis were significant increased from the second day of treatment until after 28 days of treatment (p = 0.0006), however, these in non-erosive reflux disease were significant increased from third days until after 28 days of treatment (p = 0.0002). In non-erosive reflux disease, the improvement of dysmotility symptom was particularly gradual as well as of reflux symptom, too. As for results of prediction of proton pump inhibitor response (completed symptom resolution) form early symptom improvement within 1 week, it was able to predict proton pump inhibitor response from the symptom improvement rate on 3 days in reflux esophagitis and on day 7 in non-erosive reflux disease. In conclusion, the prediction of the proton pump inhibitor response in non-erosive reflux disease was slow in comparison with reflux esophagitis. The cause was gradual improvement of dysmotility symptom.

Keywords: endoscopy: upper GI; esophagus; gastroesophagus reflux disease; the frequency scale for the symptoms of GERD.

Fig. 1

Frequency Scale for Symptoms of GERD (FSSG). Frequency Scale for the Symptoms of GERD (FSSG) is a multiple-choice questionnaire, comprising 12 questions (Q1–12), that grades the frequency of each GERD symptom (never = 0, occasionally = 1, sometimes = 2, often = 3, always = 4). The FSSG contains the 12 symptoms (FSSG total score: F-TS) most commonly experienced by patients with GERD, with 7 of the 12 related to reflux symptoms (FSSG reflux score: F-RS) and the remaining 5 related to dysmotility symptoms (FSSG dysmotility score: F-DS).

Fig. 2

Comparison of F-TS (Total Score) between RE and NERD. A significant decrease was seen in the FSSG in both RE (closed circle -●-) and NERD (opened circle -○-) from the first day of treatment. From the first day of treatment until after 28 days of treatment, the FSSG was significantly lower in RE than in NERD. *p<0.05 RE vs NERD. **p<0.001 RE vs NERD. ^†p<0.05 vs F-TS at baseline: RE. ^‡p<0.05 vs F-TS at baseline: NERD.

Fig. 3

Improvement Rates of F-TS between RE (black bar) and NERD (white bar). The symptomatic improvement rates in RE were significant increased from the second day until after 28 days of treatment, however, these in NERD were significant increased from third day until after 28 days of treatment. *p<0.05 RE vs NERD. **p<0.001 RE vs NERD. ^†p<0.05 vs improvement rate on Day 1 in RE. ^‡p<0.05 vs improvement rate on Day 1 in NERD.

Fig. 4

Improvement Rates of F-RS (left side) and F-DS (right side) according to RE (black bar) and NERD (white bar). The symptomatic improvement rates of F-RS in RE were significant increased from the second day until after 28 days of treatment, however, these in NERD were significant increased from third days until after 28 days of treatment. The symptomatic improvement rates of F-DS in RE and NERD were significant increased from the third day until after 28 days of treatment. *p<0.05 RE vs NERD. **p<0.001 RE vs NERD. ^†p<0.05 vs improvement rate on Day 1 in RE. ^‡p<0.05 vs improvement rate on Day 1 in NERD.