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Digestive Diseases and Sciences

, Volume 52, Issue 4, pp 983–987 | Cite as

Proton Pump Inhibitors: Effective First-Line Treatment for Management of Dyspepsia

  • David A. PeuraEmail author
  • Jeff Gudmundson
  • Nancy Siepman
  • Betsy L. Pilmer
  • James Freston
OrginalPaper

Abstract

The aim of this study was to evaluate the reasons for trial exclusion among dyspeptic patients and estimate the proportion that may have benefited from proton pump inhibitor (PPI) therapy. Stringent inclusion criteria for enrollment in two multicenter functional dyspepsia trials included dyspepsia (predominant persistent/recurrent upper abdominal discomfort [UAD] during the prior 3 months) of at least moderate intensity during ≥30% of days during the prior 2 to 3 weeks. Exclusion criteria were mild/infrequent UAD; heartburn and UAD of equal frequency; predominant heartburn with UAD; endoscopic evidence of erosive esophagitis or Barrett’s or gastric and/or duodenal erosions (>5) or ulcers; irritable bowel syndrome (IBS); other gastrointestinal diagnoses; or other “non-categorized” disorders. Of 2,588 screened patients, 1,667 were excluded. Excluded patients by category had mild/infrequent UAD (12.5%, n=324), heartburn and UAD of equal frequency (1.1%, n=29), predominant heartburn with UAD (11.6%, n=300), endoscopic evidence of erosive esophagitis or Barrett's (6.2%, n=160), gastric and/or duodenal erosions (1.4%, n=36), gastric and/or duodenal ulcers (2.0%, n=53), IBS (7%, n=180), “other” gastrointestinal diagnoses (2.8%, n=73), or other “non-categorized” disorders (19.8%, n=512). Fifty-four percent of patients (902/1,667) had symptoms/diagnoses that would be expected to improve with PPI therapy. Individuals with IBS, “other,” or “non-categorized” disorders were considered to have symptoms unlikely to respond to PPI treatment. Empiric PPI treatment would be expected to provide symptom relief to the majority of dyspepsia sufferer who present in clinical practice. PPIs represent the best currently available therapy for acid-related disorders and should be considered the first-line management approach in patients with uninvestigated dyspepsia.

Keywords

Functional dyspepsia Proton pump inhibitor 

Abbreviations

FD

functional dyspepsia

FDA

Food and Drug Administration

GERD

gastroesophageal reflux disease

H2RAs

histamine-2 receptor antagonists

IBS

irritable bowel syndrome

OTC

over the counter

PPI

proton pump inhibitor

UAD

upper abdominal discomfort

Notes

Acknowledgment

Research was funded by TAP Pharmaceutical Products Inc., Lake Forest, IL.

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Copyright information

© Springer Science+Business Media, Inc. 2007

Authors and Affiliations

  • David A. Peura
    • 1
    Email author
  • Jeff Gudmundson
    • 2
  • Nancy Siepman
    • 2
  • Betsy L. Pilmer
    • 2
  • James Freston
    • 3
  1. 1.University of Virginia Health Sciences CenterCharlottesvilleUSA
  2. 2.TAP Pharmaceutical Products Inc.Lake ForestUSA
  3. 3.University of Connecticut Health CenterFarmingtonUSA

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