Possible etiology of improvements in both quality of life and overlapping gastroesophageal reflux disease by proton pump inhibitor treatment in a prospective randomized controlled trial

BMC Gastroenterology

Anne Tholen⁵  Peter Sander⁶  Reinhold Lühmann⁶  Carmen Theek¹  Andrzej Straszak²  Christo van Rensburg³  Thomas Schwan⁶  Hubert Mönnikes⁴ 

[1] Pierrel Research, Essen, Germany;Department of Internal Medicine, City Hospital, Siemianowice Śląskie, Poland;Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa;Department of Medicine and Institute of Neurogastroenterology, Academic Teaching Hospital Martin Luther, Charité - Universitätsmedizin Berlin, Caspar-Theyß-Str. 27-31, Berlin, 14193, Germany;Takeda Pharmaceuticals International GmbH, Zürich, Switzerland;Nycomed GmbH, Nycomed: a Takeda Company, Konstanz, Germany

关键词: Proton pump inhibitor (PPI);    Inflammatory bowel diseases (IBD);    Irritable bowel syndrome (IBS);    Functional dyspepsia (FD);    Gastroesophageal reflux disease (GERD);   

Others  :  857567
DOI  :  10.1186/1471-230X-13-145

 received in 2013-07-02, accepted in 2013-09-24,  发布年份 2013

【 摘 要 】

Background

Symptoms suggestive of functional dyspepsia (FD) and irritable bowel syndrome (IBS) frequently overlap with those of gastroesophageal reflux disease. Despite the high prevalence of symptomatic overlap, the underlying etiology remains poorly defined. We assessed the correlation of symptomatic relief and health-related quality of life (HRQoL) with healing of reflux esophagitis to further derive insights into the underlying etiology.

Methods

626 patients with reflux esophagitis were enrolled into one of two treatment groups (classical healing concept or the complete remission concept) to investigate differences in treatment intensity. Patients were treated with pantoprazole until esophageal mucosal healing. Remission was followed for up to 6 months without treatment. Gastro-intestinal symptoms and HRQoL were analyzed using disease-specific, psychometrically validated patient-reported outcome instruments (ReQuest™, GERDyzer™).

Results

Symptomatic burden reflected by ReQuest™ substantially decreased from baseline to end of treatment by 83% and 88% in either treatment group, respectively. ReQuest™ scores significantly decreased in patients with or without heartburn and in those with symptoms suggestive of FD and IBS, indicating response of all symptom categories to treatment (p < 0.005). Therapy-associated relief of symptoms was paralleled by substantial gains in HRQoL, which continued to stabilize post-treatment.

Conclusions

Pantoprazole is effective in relieving upper and lower gastro-intestinal symptoms overlapping with erosive esophagitis, and provides sustained improvement in HRQoL post-treatment. Our results propose a link between both healing of erosive esophagitis and the slower remission of upper and lower gastro-intestinal symptoms. Since the improvement observed is likely to be multifactorial, the possibility for an immune-mediated etiology and identification of putative susceptibility factors by genome-wide association study may provide focus for future research.

Trial registration

ClinicalTrials.gov identifier: NCT00325676.

【 授权许可】

   
2013 Mönnikes et al.; licensee BioMed Central Ltd.

【 图 表 】

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