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Risk factors for relapse of erosive GERD during long-term maintenance treatment with proton pump inhibitor: a prospective multicenter study in Japan

  • Original Article—Alimentary Tract
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Abstract

Background

Despite low gastric acid secretion levels among elderly people and Helicobacter pylori-positive individuals in Japan, many patients suffer from endoscopic relapse of erosive gastroesophageal reflux disease (GERD) during standard-dose proton pump inhibitor (PPI) maintenance therapy. We aimed to investigate the relapse rate and risk factors for relapse during long-term PPI therapy in a prospective multicenter study.

Methods

Patients diagnosed endoscopically as having erosive GERD according to the Los Angeles (LA) classification, with remission under PPI medication, and without mucosal damage in the esophagus, were enrolled and took rabeprazole 10 mg/day, the standard dose in Japan, for up to 104 weeks, with endoscopy at weeks 24, 52, 76, and 104; erosive GERD with LA classification grade A, B, C, or D was defined as relapse.

Results

The baseline status of the 191 cases analyzed was: female (34.6%), ≥65 years old (50.8%), H. pylori-positive (40.8%), body mass index (BMI) ≥25 kg/m2 (35.6%), and hiatus hernia (79.6%). Relapse occurred by week 104 in 21 cases (11%; 12 females, 9 males). Risk factors were hiatus hernia; severe past erosive GERD (grade C or D); H. pylori-negative; no mucosal atrophy; nonsmoking; and being female and <150 cm in height.

Conclusions

This study revealed the significant risk factors that might be monitored during long-term maintenance therapy to prevent relapse of GERD.

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Acknowledgments

We would like to thank five members of the staff of Eisai Co., Ltd. (Yasuhiro Marukawa, Toshihisa Arai, Kazutaka Matsuo, Toshiyuki Tamai, and Yukinori Sakata) for their kind assistance in preparing the manuscript.

Conflict of interest statement

This study was funded by Eisai Co., Ltd. Kazuma Fujimoto and Michio Hongo are members of advisory committees of Eisai Co., Ltd.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan

    Kazuma Fujimoto

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

    Michio Hongo

Authors
  1. Kazuma Fujimoto
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  2. Michio Hongo
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The Maintenance Study Group

Corresponding author

Correspondence to Kazuma Fujimoto.

Additional information

Members of the Maintenance Study Group are listed in the Appendix.

Appendix: Members of the Maintenance Study Group

Appendix: Members of the Maintenance Study Group

Tsuyoshi Yabana and Takeaki Kobayashi, Doto Hospital, Sapporo, Japan; Masashi Nomura, Masafumi Yoshida, Shinya Mitsui, and Akio Katanuma, Teine Keijinkai Hospital, Sapporo, Japan; Masafumi Komatsu and Akira Zeniya, Akita City Hospital, Akita, Japan; Kazutoshi Fukase, Katsuhiro Mabe, Chieko Kato, and Yasukuni Suzuki, Yamagata Prefectural Central Hospital, Yamagata, Japan; Yasutoshi Saito, Jizankai Medical Foundation Tsuboi Cancer Center Hospital, Koriyama, Japan; Nobuo Toda, Susumu Kurosawa, Rei Kashima, and Tetsuo Ebihara, Teikyo University Chiba Medical Center, Ichihara, Japan; Toshihide Maruyama, Juntendo University Urayasu Hospital, Urayasu, Japan; Ryoichi Wada, Tokuhisa Sezaki, and Nobuto Hirata, Kameda Medical Center, Kamogawa, Japan; Yasushi Kuyama, Taro Ishii, and Takatsugu Yamamoto, Teikyo University School of Medicine, Tokyo, Japan; Jun Miwa and Yasuo Matsubara, Toshiba General Hospital, Tokyo, Japan; Nobuyuki Matsuhashi, Yukihiro Sakurai, Masako Asayama, Koji Higa, and Tomohiko Hasue, Kanto Medical Center NTT EC, Tokyo, Japan; Hirokazu Komatsu, Kiyoko Imamura, Shigeru Yamanaka, Yoshio Hosaka, Yuriko Hara, and Shuichi Nagakubo, Yokohama Municipal Citizen’s Hospital, Yokohama, Japan; Sotaro Fujimoto, Hiromu Kutsumi, Nobuaki Yagi, and Masahiro Arai, Kyoto First Red Cross Hospital, Kyoto, Japan; Kenjiro Yasuda, Masatoshi Miyata, Munehiro Sakata, Moose Ueda, and Mami Ogawa, Kyoto Second Red Cross Hospital, Kyoto, Japan; Toshiki Takemura, Hideto Inokuchi, Masataka Matsushita, Kengo Takimoto, and Hideyuki Shiomi, Ijinkai Takeda General Hospital, Kyoto, Japan; Takama Maekawa, National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Yukimasa Yamashita, Toko Kaneshiro, and Masamichi Nasu, Miki City Hospital, Miki, Japan; Kazuhiko Inoue and Osamu Mihara, Matsue Red Cross Hospital, Matsue, Japan; Shiro Okamoto and Kanji Kodama, Kure Kyosai Hospital, Kure, Japan; Toru Hidaka, Hiroshima City Asa Hospital, Hiroshima, Japan; Akira Tari and Hiroshi Tani, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital, Hiroshima, Japan; Tomoki Inaba and Masaki Wato, Kagawa Prefectural Central Hospital, Takamatsu, Japan; Shuji Inoue, Sae Kujime, and Kozo Fuke, National Hospital Organization Kochi Hospital, Kochi, Japan; Masahito Nakauchi, Chiaki Watanabe,and Kazuo Nakajo, Jinsei-kai Hosogi Hospital, Kochi, Japan; Yozo Iida and Noboru Maetani, Kokura Memorial Hospital, Kitakyushu, Japan; Ryuichiro Maekawa, Shinichi Iwanaga, Masaru Sasaki, and Hajime Aino, Social Insurance Tagawa Hospital, Tagawa, Japan; Kazuma Fujimoto, Ryuichi Iwakiri, Hiroyuki Sakata, and Akifumi Ootani, Saga Medical School, Saga, Japan.

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Fujimoto, K., Hongo, M. & The Maintenance Study Group. Risk factors for relapse of erosive GERD during long-term maintenance treatment with proton pump inhibitor: a prospective multicenter study in Japan. J Gastroenterol 45, 1193–1200 (2010). https://doi.org/10.1007/s00535-010-0276-7

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  • DOI: https://doi.org/10.1007/s00535-010-0276-7

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