Efficacy of low-dose lansoprazole in the treatment of non-erosive gastroesophageal reflux disease: Influence of infection by Helicobacter pylori

Abstract

Introduction: proton pump inhibitors (PPIs) are the most effective drugs to cure peptic esophagitis and control the symptoms of gastroesophageal reflux disease (GERD). In most patients with GERD esophagitis is not detected by endoscopy, which represents GERD with a negative endoscopy or non-erosive reflux disease (NERD). The influence of infection by H. pylori in the evolution of GERD is controversial since a protective action is identified by some studies, but not all. We conducted a clinical trial to assess the efficacy of lansoprazole 15 mg/day in the initial control of NERD symptoms, and as a secondary endpoint the impact of H. pylori infection on response to treatment. Patients and methods: a pilot, single-center clinical trial was conducted-single-blind regarding the experimental medication (unknown to patients), and double-blind regarding the information concerning H. pylori infection. Sixty (60) patients with NERD were initially included, who had suffered from daytime or nocturnal heartburn for 1-2 days in each of the last two weeks. Nine patients were excluded for failing to comply with the study protocol. The 51 remaining patients, 35 women and 16 men, with a mean age of 49 years, comprised the per protocol analysis population. Patients received treatment for two weeks with a capsule of the study medication (15 mg/day of lansoprazole), with daily controls on the presence and severity of daytime and nocturnal heartburn. Treatment was considered effective when, upon completion, patients referred a maximum of one episode of mild heartburn as defined in the protocol, or answered the following question in the affirmative: "Does the medication you are receiving satisfactorily control the symptoms of your disease?". During diagnostic endoscopy we obtained biopsies of the gastric body and antrum to investigate infection by H. pylori by means of a urease test. Treatment efficacy was assessed with no patients or doctors responsible for the study being aware of urease test results. Results: 41 patients (80.3%) reported that treatment had satisfactorily controlled their symptoms, and 34 patients (66.6%) had a maximum of one episode of mild heartburn in the last week. Forty-two (42) patients (82.3%) had infection by H. pylori. No significant differences were observed in the response to treatment between patients with or without H. pylori infection. Conclusions: with the limitations of a pilot study, these results suggest that lansoprazole 15 mg/day is an effective treatment in the control of NERD symptoms, that it may be a good initial therapeutic strategy, and that, according to data available, H. pylori infection has no significant effect on the response to treatment.

Clinical trials: healing of erosive oesophagitis with dexlansoprazole MR, a proton pump inhibitor with a novel dual delayed‐release formulation – results from two randomized controlled studies

“…A study by Holtmann et al 43 . showed that patients infected with H. pylori experienced better healing rates and symptom relief, whereas other studies did not demonstrate an association between healing rates and H. pylori infection 44, 45 . In the absence of definitive data regarding the effect of H. pylori infection on clinical outcomes of therapy with PPIs, it would not be unreasonable to expect that the results of the current study would be similar had patients infected with H. pylori been enrolled.…”

Preoperative workup to assess indication for laparoscopic treatment in gastroesophageal reflux disease

“…In our subjects, mean time with symptoms and mean time with medication seemed to be so long. This fact could be explained because half the patients could have remained without interference with daily activities for long time in absence of erosive esophagitis, in addition to most of patients did take adequate medical treatment with proton pump inhibitor (PPI) (19). Despite our patients seemed to have waited for so long, the neccesity of long-term treatment with PPI is the basis for establishing an indication for antireflux surgery (20).…”

“…Subjects included in this study have been under PPI for so long (19), half of them have presented reflux esophagitis or complicactions (1), and half of them have showed an abnormal DeMeester score in pH-monitoring test. Indications for surgery consisted of significant limitation of health-related well-being such as quality of life (in 30 cases), persistent or recurrent esophagitis in spite of treatment in 52 cases, and complications of the disease (stenoses, ulcers, and Barret's esophagus) in 12 cases.…”

“…Data analysed retrospectively revealed that most of patients could be classified as severe GERD, based on the facts that most of them have been under PPI for so long (19); and despite that, the severity of their symptoms, their recurrence or persistence, or the mucosal damage that was present did make them to be candidates for surgery (1,2).…”

Alterations of Mast Cells in the Esophageal Mucosa of the Patients With Non-Erosive Reflux Disease

“…Rebound acid hypersecretion develops after the use of proton pump inhibitors (PPI). Otherwise, nowadays the most widespread opinion is that there is no consistent relationship between GERD and H. pylori infection [25-27]. …”