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Pre-dinner administration increases the efficacy of proton pump inhibitors on refractory GERD symptoms in connective tissue disease patients

  • Original Article
  • Published:
Modern Rheumatology

Abstract

Background

A significant proportion of patients with connective tissue disease (CTD) have gastric esophageal reflux disease (GERD) symptoms despite receiving proton pump inhibitors (PPIs). Although pre-meal administration of PPIs is recommended in Western countries, the benefit of this administration timing in Japanese CTD patients with refractory GERD symptoms has not been proven.

Objective

To determine whether pre-dinner administration of PPIs is more efficacious for refractory GERD symptoms in Japanese CTD patients.

Methods

CTD patients receiving oral PPIs were instructed to take PPIs 1 h before dinner. Gastrointestinal symptoms were evaluated with frequency scale for the symptoms of GERD (FSSG) and gastrointestinal symptom rating scale (GSRS) before and after the intervention.

Results

Pre-dinner administration of PPIs significantly improved FSSG total score, from a median of 8 to 6.5 (P = 0.005). Pre-dinner administration was more effective in patients with overt GERD symptoms (from median 18 to 10, P < 0.001) than in those with mild GERD symptoms (from median 2 to 2, P = 0.201). In addition to reflux syndrome, pre-dinner administration of PPIs significantly decreased abdominal pain syndrome and constipation syndrome of GSRS.

Conclusion

Pre-dinner administration of PPIs may increase their efficacy in Japanese CTD patients with GERD, especially those with overt symptoms.

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Acknowledgments

We thank Dr. H. Iwata (Department of Surgery, Shinkatsushika Hospital, Tokyo), a board-certified gastroenterologist, for evaluation of endoscopic findings and valuable discussion. This work was supported in part by Grants-in-Aids for Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology, the Japanese Government and by Global COE Program (Global Center for Education and Research in Immune System Regulation and Treatment), MEXT, Japan.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Allergy and Clinical Immunology, Chiba University Hospital, 1-8-1 Inohana, Chiba, Chiba, 260-8670, Japan

    Arifumi Iwata, Kei Ikeda, Koichi Hirose, Hiroaki Takatori, Kentaro Takahashi, Yoshie Sanayama, Shigeru Tanaka, Akira Suto & Hiroshi Nakajima

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  1. Arifumi Iwata
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  2. Kei Ikeda
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  3. Koichi Hirose
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  4. Hiroaki Takatori
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  6. Yoshie Sanayama
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  7. Shigeru Tanaka
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  8. Akira Suto
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  9. Hiroshi Nakajima
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Correspondence to Arifumi Iwata.

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Iwata, A., Ikeda, K., Hirose, K. et al. Pre-dinner administration increases the efficacy of proton pump inhibitors on refractory GERD symptoms in connective tissue disease patients. Mod Rheumatol 23, 357–364 (2013). https://doi.org/10.1007/s10165-012-0662-5

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  • DOI: https://doi.org/10.1007/s10165-012-0662-5

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