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Clinical Characteristics of Patients with Gastroesophageal Reflux Disease Refractory to Proton Pump Inhibitors and the Effects of Switching to 20 mg Esomeprazole on Reflux Symptoms and Quality of Life

Fuminao Takeshima, Keiichi Hashiguchi, Yasunori Onitsuka, Ken Tanigawa, Hitomi Minami, Kayoko Matsushima, Yuko Akazawa, Ken Shiozawa, Naoyuki Yamaguchi, Naota Taura, Ken Ohnita, Tatsuki Ichikawa, Hajime Isomoto, Kazuhiko Nakao

Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan

Med Sci Monit 2015; 21:4111-4121

DOI: 10.12659/MSM.895346

Available online:

Published: 2015-12-31


BACKGROUND: Refractory gastroesophageal reflux disease (GERD) may deteriorate patient quality of life (QOL) despite proton pump inhibitor (PPI) therapy.
MATERIAL AND METHODS: Nineteen Japanese institutions were surveyed to determine the clinical characteristics and QOL of patients with refractory GERD. Those patients treated with a conventional PPI were switched to 20 mg esomeprazole for 4 weeks. Symptoms and QOL were assessed using Global Overall Symptom and Gastrointestinal Symptom Rating Scale (GSRS) questionnaires at baseline and at 2 and/or 4 weeks of esomeprazole treatment.
RESULTS: Of 120 patients who completed the survey, 58 (48.3%) had refractory GERD. Of these, 69.0% were aged ≥65 years, 79.3% were prescribed a PPI at a standard or high dose, and 22.4% were prescribed a PPI together with another drug. After switching to esomeprazole, patients reported significant improvements in heartburn, acid regurgitation, and excessive belching at 2 weeks using a symptom diary, as well as the total score, reflux, abdominal pain, and indigestion, which were assessed using the GSRS at 4 weeks.
CONCLUSIONS: About half of Japanese patients with GERD may be refractory to conventional PPIs. Their reflux-related symptoms are often severe and may impair QOL. Switching to esomeprazole could be used to improve their symptoms and QOL.

Keywords: Aged, 80 and over, Adult, Esomeprazole - therapeutic use, Gastroesophageal Reflux - physiopathology, Prospective Studies, Proton Pump Inhibitors - therapeutic use, Quality of Life, Severity of Illness Index, Surveys and Questionnaires



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