Prediction of response to PPI therapy and factors influencing treatment outcome in patients with GORD: a prospective pragmatic trial using pantoprazole

Heading, R C; Mönnikes, Hubert; Tholen, Anne; Schmitt, H.

doi:10.1186/1471-230x-11-52

Cited by 51 publications

(55 citation statements)

References 63 publications

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“…79,[110][111][112][113] In a study conducted in patients newly diagnosed with GERD in primary care clinics, partial symptomatic response to PPI therapy was found to be related to women (OR, 1.20; 95% CI, 1.05-1.37). 111 In a systemic review, persistent GERD symptoms despite PPI treatment were more likely to be revealed in women than in men (risk ratio [RR]: 3.66; P < 0.001).…”

Section: Sex/gender and Treatment Responsementioning

confidence: 99%

“…116 Several recent studies have suggested that women, lower BMI, and psychologic disorders such as anxiety and depression was related to poor response to PPI therapy in patients with GERD, 112,117 while men, obesity, typical reflux symptoms such as heartburn and regurgitation, and alcohol consumption was related to positive therapeutic responses to PPIs in a retrospective study of 683 subjects suspected of GERD who underwent pH-metry/ impedance measurement (pH/MII). 116 It has been suggested that pH/MII (including evaluation of the symptom index) instead of empiric PPI therapy should be considered in non-obese women with atypical reflux symptoms.…”

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confidence: 99%

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Sex and Gender Differences in Gastroesophageal Reflux Disease

Kim

2016

J Neurogastroenterol Motil

122

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It is important to understand sex and gender-related differences in gastroesophageal reflux disease (GERD) because gender-related biologic factors might lead to better prevention and therapy. Non-erosive reflux disease (NERD) affects more women than men. GERD symptoms are more frequent in patients with NERD than in those with reflux esophagitis. However, men suffer pathologic diseases such as reflux esophagitis, Barrett's esophagus (BE), and esophageal adenocarcinoma (EAC) more frequently than women. The prevalence of reflux esophagitis is significantly increased with age in women, especially after their 50s. The mean age of EAC incidence in women is higher than in men, suggesting a role of estrogen in delaying the onset of BE and EAC. In a chronic rat reflux esophagitis model, nitric oxide was found to be an aggravating factor of esophageal injury in a male-predominant way. In addition, the expression of esophageal occludin, a tight junction protein that plays an important role in the esophageal defense mechanism, was up-regulated in women. This explains the male predominance of reflux esophagitis and delayed incidence of BE or EAC in women. Moreover, the symptoms such as heartburn, regurgitation, and extra-esophageal symptoms have been more frequently reported by women than by men, suggesting that sex and gender play a role in symptom perception. Differential sensitivity with augmented symptoms in women might have diagnostic and therapeutic influence. Furthermore, recent studies have suggested that hormone replacement therapy has a protective effect against esophageal cancer. However, an anti-inflammatory role of estrogen remains compelling, which means further study is necessary in this area.

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Section: Sex/gender and Treatment Responsementioning

confidence: 99%

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confidence: 99%

Sex and Gender Differences in Gastroesophageal Reflux Disease

Kim

2016

J Neurogastroenterol Motil

122

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“…[5][6][7] Several recent studies suggest that female gender, lower body mass index (BMI), anxiety, and depressive disorders are associated with poor response to PPI treatment in patients with GERD. 8,9 However, response rates and related factors after PPI therapy are significantly different by country. Thus, well-designed studies for assessing the efficacy of PPI therapy in patients with GERD symptoms are needed.…”

Section: Introductionmentioning

confidence: 99%

Predictive Factors of Response to Proton Pump Inhibitors in Korean Patients With Gastroesophageal Reflux Disease

Kim

et al. 2015

J Neurogastroenterol Motil

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Background/Aims Proton pump inhibitors (PPIs) are widely used in the treatment of gastroesophageal reflux disease (GERD). However, some patients fail to respond to PPI therapy. We investigated the efficacy of response to PPI therapy in patients with GERD symptoms. Methods A total of 179 subjects with GERD symptoms were prospectively enrolled and diagnosed with non-erosive reflux disease (NERD, n = 100) and erosive reflux disease (n = 79) by gastroscopy and Bernstein test and/or 24-hour esophageal pH testing. Subjects then received a standard dose of daily PPI therapy for at least 4 weeks. PPI therapy response was evaluated using questionnaires including questions about demographics, GERD symptoms, GERD impact scale, Epworth sleepiness scale, Pittsburgh sleep quality index (PSQI), hospital anxiety and depression scale, and abbreviated version of the World Health Organization quality of life scale. Results The rates of complete (≥ 80%), satisfactory (≥ 50%), partial (< 50%), and refractory response in the 179 participants were 41.3%, 30.2%, 18.4%, and 10.1%, respectively. Thus, overall response rate (complete and satisfactory responses) was 71.5%. Multivariate analysis showed body mass index < 23 kg/m 2 (OR, 2.20; 95% CI, 1.12–4.34), higher total PSQI score (OR, 1.20; 95% CI, 1.05–1.35), history of psychotherapy or neuropsychiatric medication (OR, 2.44; 95% CI, 1.23–4.85), and NERD (OR, 3.30; 95% CI, 1.54–7.11) were associated with poor response to PPI therapy. Conclusions Psychological factors, sleep dysfunction, body mass index < 23 kg/m 2 , and NERD seem to be the major factors that lead to a poor response to PPI treatment in patients with GERD symptoms.

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“…Optimal treatment endurance should be active for a period of between two and eight weeks [4,5]. Supplementary indications include short courses of treatments for prevention of stress ulcers in critically ill patients, as well as for primary and secondary prevention of gastrointestinal haemorrhage.…”

Section: Introductionmentioning

confidence: 99%

Connections between nutritional status and proton pump inhibitor therapy in patients scheduled for cardiovascular rehabilitation after treatment for ischaemic and valvular heart disease

et al. 2016

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A b s t r a c t Background:Multiple and yet uncertain connections exist between cardiovascular diseases and the nutritional status of patients, particularly in relation to cardiovascular treatments. Proton pump inhibitors (PPI) are among the most commonly used group of drugs. Aim:To analyse utilisation of PPI in association with nutritional risk of patients scheduled for rehabilitation after treatment for ischaemic and valvular heart disease. Methods:Retrospective analyses on a consecutive sample of patients, which included drug utilisation of PPI and nutritional risk screening, using a standardised NRS-2002 tool. The patients (n = 536) were divided into groups based on previous cardiovascular treatments and use of PPI.Results: Nearly half of the patients (244, 46.1%) had PPI in their chronic therapy despite the clinically negligible prevalence of conditions that are their fundamental indications. The odds for using PPI in patients with increased nutritional risk, estimated by logistic regression, were 3.34 (95% confidence intervals [CI] 2.26-4.94), p < 0.001. Receiver operating curve analyses also revealed significant differences of PPI utilisation in connection with NRS-2002 > 3: positive likelihood-ratio (LR) 2.35 (95% CI 2.10-2.60); negative LR 0.46 (95% CI 0.4-0.6); area under the curve (AUC) 0.720; p < 0.001; as well as the percentage weigh loss history > 6.36% (positive LR 2.22 [95% CI 2.00-2.50]; negative LR 0.41 [95% CI 0.30-0.50]; AUC 0.707; p < 0.001).Conclusions: Utilisation of PPI was found to be of relatively high prevalence and significantly associated with parameters of nutritional risk screening. Furthermore, it was in correlation with the age of patients and the existence of chronic kidney disease, which are well-established predispositions for poor nutritional status. Nutritional risk seems to be additionally negatively challenged by utilisation of PPI due to gastric malabsorption and anaemia.

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Prediction of response to PPI therapy and factors influencing treatment outcome in patients with GORD: a prospective pragmatic trial using pantoprazole

Cited by 51 publications

References 63 publications

Sex and Gender Differences in Gastroesophageal Reflux Disease

Sex and Gender Differences in Gastroesophageal Reflux Disease

Predictive Factors of Response to Proton Pump Inhibitors in Korean Patients With Gastroesophageal Reflux Disease

Connections between nutritional status and proton pump inhibitor therapy in patients scheduled for cardiovascular rehabilitation after treatment for ischaemic and valvular heart disease

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