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Combination of angiotensin II receptor blockers promotes proton pump inhibitor-based healing of reflux esophagitis

  • Original Article—Alimentary Tract
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Abstract

Background

Several studies have described factors associated with the failure of proton pump inhibitors (PPIs) to effect endoscopic healing of reflux esophagitis (RE), but few studies have addressed factors promoting PPI-based endoscopic healing. We performed post hoc analysis of a multicenter prospective cohort of RE patients to identify factors encouraging endoscopic healing of this disorder.

Methods

Patients with RE received 10 or 20 mg rabeprazole for 8 weeks, and endoscopic findings before and after treatment were studied. To evaluate the effects of patient background factors on endoscopic healing, we performed multiple logistic regression analysis and determined the respective odds ratios (ORs) and 95% confidence intervals (CIs).

Results

A total of 454 patients who underwent endoscopy at baseline and again at week 8 were included in the analysis. After 8 weeks of treatment, improvement in endoscopic findings was observed in 94.1% (427/454) of patients, and endoscopic healing was seen in 76.7% (348/454). Multiple logistic regression analysis revealed that a combination of angiotensin II receptor blockers (ARBs) had a significant positive impact on endoscopic healing (OR 3.9, 95% CI 1.411–10.903), but no significant positive relationship was seen for other concomitant drugs such as nonsteroidal anti-inflammatory drugs and calcium channel blockers. Severe RE at baseline (OR 0.365, 95% CI 0.281–0.475) and PPI therapy prior to enrollment (OR 0.154, 95% CI 0.052–0.453) were found to have significant negative effects on endoscopic healing.

Conclusions

Concomitant use of ARBs may promote endoscopic healing of RE treated with PPIs.

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Acknowledgments

The authors would like to thank the physicians at the 1,326 institutions in the J-FAST group, and would also like to thank Kimihide Shiozawa, Kai Shibata and Yukinori Sakata for their kind assistance in preparing the manuscript.

Conflict of interest

This study was supported by Eisai Co., Ltd. Hiroto Miwa, MD, PhD, serves as a consultant to Eisai Co., Ltd., AstraZeneca KK, Dainippon-Sumitomo Pharma Co., Ltd., Takeda Pharmaceutical Co., Ltd., and Tsumura & Co. Michio Hongo, MD, PhD, serves as a consultant to Eisai Co., Ltd., Abbott Japan Co., Ltd., Astellas Pharma Inc., AstraZeneca KK, Asubio Pharma Co., Ltd., Dainippon-Sumitomo Pharma Co., Ltd., Kyowa Hakko Co. Ltd, Sucampo Pharmaceuticals, Inc., Takeda Pharmaceutical Co., Ltd. and Zeria Pharmaceutical Co., Ltd. Motoyasu Kusano, MD, PhD, serves as a consultant to Eisai Co., Ltd.

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Authors and Affiliations

  1. Division of Upper Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan

    Hiroto Miwa

  2. Department of Comprehensive Medicine and Psychosomatic Medicine, Tohoku University Hospital, Sendai, Japan

    Michio Hongo

  3. Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, Maebashi, Japan

    Motoyasu Kusano

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  1. Hiroto Miwa
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  2. Michio Hongo
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The J-FAST Group

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Correspondence to Hiroto Miwa.

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Miwa, H., Hongo, M., Kusano, M. et al. Combination of angiotensin II receptor blockers promotes proton pump inhibitor-based healing of reflux esophagitis. J Gastroenterol 47, 249–255 (2012). https://doi.org/10.1007/s00535-011-0479-6

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  • DOI: https://doi.org/10.1007/s00535-011-0479-6

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