Factors affecting response to proton pump inhibitor therapy in patients with gastroesophageal reflux disease: a multicenter prospective observational study
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Proton pump inhibitor (PPI) therapy, the first-line treatment for gastroesophageal reflux disease (GERD), is not always effective. This study aimed to examine the effect of pretreatment patient characteristics on response to PPI therapy.
Japanese outpatients with symptomatic GERD scheduled to receive endoscopy and PPI therapy were enrolled in this multicenter prospective observational study. The patients’ characteristics, including GERD and dyspeptic symptoms, anxiety, depression, and quality of life, were assessed using questionnaires before and 2 and 4 weeks after the start of PPI therapy. Factors affecting therapeutic response were examined by simple and multiple regression analyses using three patient-reported outcome measures as objective variables.
Data from 182 patients were analyzed. In multiple regression analysis using the residual symptom rate as an objective variable, lower GERD symptom score (p < 0.05), absence of erosive esophagitis (p < 0.05), higher epigastric pain/burning symptom score (p < 0.05), and higher depression subscale score (p < 0.05) accompanied poorer therapeutic response. In analyses using the patient’s impression of therapy, lower GERD symptom score (p < 0.05) and absence of erosive esophagitis (p < 0.05) accompanied poorer therapeutic response. In analyses using the relative GERD symptom intensity evaluated using a numeric rating scale, lower GERD symptom score (p < 0.05), higher epigastric pain/burning symptom score (p < 0.1), and lower body mass index (p < 0.05) accompanied poorer therapeutic response.
Patients who complained of milder GERD symptoms before treatment were likely to have poorer response to PPI therapy. Association of absence of erosive esophagitis, severer epigastric pain/burning symptoms, lower body mass index, and severer depression with poorer therapeutic response was also suggested.
KeywordsGastroesophageal reflux disease Dyspeptic symptoms Depression Anxiety Therapeutic response to proton pump inhibitor therapy
Body mass index
Erosive reflux disease
Gastroesophageal reflux disease
Gastroesophageal reflux and dyspepsia-therapeutic efficacy and satisfaction test
Hospital anxiety and depression scale
Irritable bowel syndrome
Nonerosive reflux disease
Numeric rating scale
Proton pump inhibitor
Quality of life
We are grateful to the GERD Society for support of publication of this work. Assistance in statistical analyses and writing was funded by AstraZeneca (Osaka, Japan).
Conflict of interest
Kazunari Murakami received research grants and lecture fees from Takeda Pharmaceutical and Eisai. Mototsugu Kato received research grants and lecture fees from AstraZeneca, Daiichi Sankyo, Takeda Pharmaceutical, and Eisai. Takashi Joh received research grants from AstraZeneca, Daiichi Sankyo, Takeda Pharmaceutical, and Eisai. Kazuhide Higuchi received research grants from Daiichi Sankyo, Takeda Pharmaceutical, and Eisai, and lecture fees from AstraZeneca, Daiichi Sankyo., and Eisai. Ken Haruma received research grants and lecture fees from AstraZeneca, Daiichi Sankyo, Takeda Pharmaceutical, and Eisai. The other authors declare that they have no conflict of interest.
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