High‐dose esomeprazole is required for intraesophageal acid control in gastroesophageal reflux disease patients with hiatus hernia

Peng, Sui; Xiao, Yinglian; Chen, Yi; Lin, Jin-kun; Zhang, Ning; Hu, Pinjin; Chen, Minhu

doi:10.1111/j.1440-1746.2011.06969.x

Cited by 8 publications

(6 citation statements)

References 25 publications

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“…However, the high dose of PPI treatment may be effective for these non-EMD patients with excessive acid reflux into the esophagus despite standard oral doses of PPI [23]. Excessive acid is a factor in increasing LES pressure in HLES patients [22].…”

Section: Discussionmentioning

confidence: 99%

The Role of Gastroesophageal Reflux in Relation to Symptom Onset in Patients with Proton Pump Inhibitor-Refractory Nonerosive Reflux Disease Accompanied by an Underlying Esophageal Motor Disorder

Izawa

Funaki²,

Iida³

et al. 2014

Digestion

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Background: The symptom improvement rate is low with proton pump inhibitors (PPIs) in nonerosive reflux disease (NERD). The underlying pathogenic mechanism is complex. Esophageal motility disorders (EMDs) are thought to be a factor, but their prevalence, type, symptoms and the role played by gastroesophageal reflux (GER) in symptom onset have not been fully investigated. Aim: To investigate the role of GER in symptom onset in PPI-refractory NERD patients with EMDs. Methods: This study comprised 76 patients withPPI-refractory NERD. Manometry was performed during PPI treatment and patients were divided into an EMD group and normal motility (non-EMD) group. Then, multichannel intraluminal impedance-pH monitoring was performed and medical interviews were conducted. Results: Nineteen patients (25%) had an EMD. Data were compared between 17 patients, excluding 2 with achalasia and 57 non-EMD patients. No significant differences were observed between groups in 24-hour intraesophageal pH <4 holding time (HT), mean number of GER episodes or mean number of proximal reflux episodes. The reflux-related symptom index (≥50%) showed a relationship between reflux and symptoms in 70.5% of EMD patients and 75% of non-EMD patients. In the EMD group, the score for FSSG (Frequency Scale for the Symptoms of GERD) question (Q)10 was significantly correlated with the number of GER episodes (r = 0.58, p = 0.02) and the number of proximal reflux episodes (r = 0.63, p = 0.02). In addition, the score for Q9 tended to be correlated with the number of GER episodes (r = 0.44, p = 0.06). Conclusion: Our results suggest that some PPI-refractory NERD patients have EMDs, and that GER plays a role in symptom onset.

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Section: Discussionmentioning

confidence: 99%

The Role of Gastroesophageal Reflux in Relation to Symptom Onset in Patients with Proton Pump Inhibitor-Refractory Nonerosive Reflux Disease Accompanied by an Underlying Esophageal Motor Disorder

Izawa

Funaki²,

Iida³

et al. 2014

Digestion

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“…The study aimed to assess the efficacy of standard dose (40 mg once daily) and double dose (40 mg twice daily) esomeprazole in patients with hiatal hernia. 40 The authors demonstrated that 53.2% (7/13) of those with hiatal hernia and 90.5% (57/63) of those without hiatal hernia, normalized their esophageal acid exposure test on standard dose, while 100% of those who received double dose esomeprazole normalized their esophageal acid exposure test. Importantly, standard dose of esomeprazole resulted in symptom control in 76.3% of the 76 subjects studied.…”

Section: Does Symptomatic Response To Ppi Treatment Require Normaliza...mentioning

confidence: 96%

“…Another prospective study included 76 patients with typical GERD symptoms and abnormal 24-hour esophageal pH monitoring. The study aimed to assess the efficacy of standard dose (40 mg once daily) and double dose (40 mg twice daily) esomeprazole in patients with hiatal hernia 40. The authors demonstrated that 53.2% (7/13) of those with hiatal hernia and 90.5% (57/63) of those without hiatal hernia, normalized their esophageal acid exposure test on standard dose, while 100% of those who received double dose esomeprazole normalized their esophageal acid exposure test.…”

Section: Does Symptomatic Response To Ppi Treatment Require Normaliza...mentioning

confidence: 99%

The Discrepancy Between Subjective and Objective Clinical Endpoints in Gastroesophageal Reflux Disease

Shibli

Sandhu²,

Fass³

2022

Journal of Clinical Gastroenterology

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Therapeutic outcome in gastroesophageal reflux disease (GERD) is commonly determined by both subjective and objective clinical endpoints. Clinicians frequently use symptom improvement as a key benchmark of clinical success, in conjunction with normalization of objective parameters such as esophageal acid exposure and inflammation. However, GERD therapeutic trials have demonstrated that a substantial number of patients rendered asymptomatic, whether through medical, surgical, or endoscopic intervention, continue to have persistent abnormal esophageal acid exposure and erosive esophagitis. The opposite has also been demonstrated in therapeutic trials, where patients remained symptomatic despite normalization of esophageal acid exposure and complete resolution of esophageal inflammation. Moreover, there is no substantive evidence that symptomatic response to antireflux treatment requires complete esophageal mucosal healing or normalization of esophageal acid exposure. Thus, it appears that a certain level of improvement in objective parameters is needed to translate into meaningful changes in symptoms and health-related quality of life of GERD patients. This supports the need to reconsider the commonly used “hard” clinical endpoints to evaluate therapeutic trials in GERD.

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“…The presence of hiatal hernia is common and a significant and independent risk factor for BE [14], especially in hernias >4 cm [15]. Surgery showed superiority over medical treatment in patients with dysmotility [16] and hiatal hernias [17]. Moreover, successful elimination of reflux symptoms with medication does not guarantee control of acid reflux, as often BE patients do not experience heartburn due to the reduced sensitivity of the columnar mucosa to the refluxate [18].…”

Section: Should Patients With Be Be Operated To Stop Gerd?mentioning

confidence: 99%

Antireflux Surgery and Barrett’s Esophagus: Myth or Reality?

2017

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High‐dose esomeprazole is required for intraesophageal acid control in gastroesophageal reflux disease patients with hiatus hernia

Abstract: The standard-dose of esomeprazole fails to normalize the esophageal pH in almost 50% of patients with hiatus hernia, in whom the "double-dose" esomeprazole therapy is required.

Cited by 8 publications

References 25 publications

The Role of Gastroesophageal Reflux in Relation to Symptom Onset in Patients with Proton Pump Inhibitor-Refractory Nonerosive Reflux Disease Accompanied by an Underlying Esophageal Motor Disorder

The Role of Gastroesophageal Reflux in Relation to Symptom Onset in Patients with Proton Pump Inhibitor-Refractory Nonerosive Reflux Disease Accompanied by an Underlying Esophageal Motor Disorder

The Discrepancy Between Subjective and Objective Clinical Endpoints in Gastroesophageal Reflux Disease

Antireflux Surgery and Barrett’s Esophagus: Myth or Reality?

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