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Journal of Gastroenterology

, Volume 50, Issue 12, pp 1173–1183 | Cite as

Factors affecting response to proton pump inhibitor therapy in patients with gastroesophageal reflux disease: a multicenter prospective observational study

  • Nobuyuki Matsuhashi
  • Mineo Kudo
  • Norimasa Yoshida
  • Kazunari Murakami
  • Mototsugu Kato
  • Tsuyoshi Sanuki
  • Atsushi Oshio
  • Takashi Joh
  • Kazuhide Higuchi
  • Ken Haruma
  • Koji NakadaEmail author
Original Article—Alimentary Tract

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Gastroesophageal reflux disease Dyspeptic symptoms Depression Anxiety Therapeutic response to proton pump inhibitor therapy 

Abbreviations

BMI

Body mass index

ERD

Erosive reflux disease

GERD

Gastroesophageal reflux disease

GERD-TEST

Gastroesophageal reflux and dyspepsia-therapeutic efficacy and satisfaction test

HADS

Hospital anxiety and depression scale

IBS

Irritable bowel syndrome

NERD

Nonerosive reflux disease

NRS

Numeric rating scale

PPI

Proton pump inhibitor

QOL

Quality of life

Notes

Acknowledgments

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.

Supplementary material

535_2015_1073_MOESM1_ESM.docx (42 kb)
Supplementary material 1 (DOCX 42 kb)
535_2015_1073_MOESM2_ESM.docx (44 kb)
Supplementary material 2 (DOCX 44 kb)

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Copyright information

© Springer Japan 2015

Authors and Affiliations

  • Nobuyuki Matsuhashi
    • 1
  • Mineo Kudo
    • 2
  • Norimasa Yoshida
    • 3
  • Kazunari Murakami
    • 4
  • Mototsugu Kato
    • 5
  • Tsuyoshi Sanuki
    • 6
  • Atsushi Oshio
    • 7
  • Takashi Joh
    • 8
    • 9
  • Kazuhide Higuchi
    • 9
    • 10
  • Ken Haruma
    • 9
    • 11
  • Koji Nakada
    • 9
    • 12
    Email author
  1. 1.Department of GastroenterologyNTT Medical Center TokyoTokyoJapan
  2. 2.Department of GastroenterologySapporo Hokuyu HospitalSapporoJapan
  3. 3.Department of GastroenterologyJapanese Red Cross Kyoto Daiichi HospitalKyotoJapan
  4. 4.Department of GastroenterologyOita University HospitalOitaJapan
  5. 5.Division of EndoscopyHokkaido University HospitalSapporoJapan
  6. 6.Department of GastroenterologyKita Harima Medical CenterOnoJapan
  7. 7.Faculty of Letters, Arts and SciencesWaseda UniversityTokyoJapan
  8. 8.Department of Gastroenterology and MetabolismNagoya City University Graduate School of Medical SciencesNagoyaJapan
  9. 9.GERD Society Study CommitteeOsakaJapan
  10. 10.Second Department of Internal MedicineOsaka Medical CollegeOsakaJapan
  11. 11.Division of Gastroenterology, Department of Internal MedicineKawasaki Medical SchoolOkayamaJapan
  12. 12.Department of SurgeryThe Jikei University School of MedicineTokyoJapan

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