Prospective Evaluation of Duodenogastroesophageal Reflux in Gastroesophageal Reflux Disease Patients Refractory to Proton Pump Inhibitor Therapy

Abstract

Background: Duodenogastroesophageal reflux (DGER) is considered an independent risk factor for complicated reflux disease (gastroesophageal reflux disease; GERD). However, the role of DGER in GERD patients refractory to proton pump inhibitors (PPI) remains poorly understood. Methods: 85 patients with clinical reflux symptoms and a history of ineffective response to PPIs were enrolled in the study. Patients with elevated reflux measurement (pH and/or Bilitec measurement; n = 47) received pantoprazole 80 mg for 8 weeks. Clinical outcome was defined as response (≤2 symptoms/week) or nonresponse (≥3 symptoms/week). Results: Of the 47 patients with elevated reflux measurement, 30 were classified as responders and 17 as nonresponders. Treatment with pantoprazole resulted in a significant reduction of acidic reflux in both PPI responders and PPI nonresponders. In contrast, DGER was only significantly reduced in the PPI responder group (22.8 ± 22.8 vs. 6.6 ± 10.8%; p < 0.05) but not in the PPI nonresponder group (24.5 ± 18.6 vs. 22.2 ± 12.7%; p > 0.05). Conclusions: The presented study firstly describes that nonresponsiveness to PPI is associated with a limited effect of PPIs on reducing DGER. Thus, persistent DGER may play a key role in mediating reflux symptoms refractory to high-dose PPIs.

Effect of Monotherapy and Combination Therapy of Pantoprazole and Aprepitant in Gastric Esophageal Reflux Disease in Albino Rats

“…Pantoprazole is a well-established drug used for the treatment of peptic ulcer, which inhibits the secretion from the gastric cells and helps in providing relief in reflux disease and mucosal curing in gastric ulcers and GERD [13]. In the present experiment pantoprazole demonstrated reduction in gastric volume, total acidity, and esophagitis index and this observation is in concordance with the previous studies.…”

A Comparative Study on Monotherapy and Combination Therapy of Pantoprazole With Pregabalin Against Surgical Esophagitis

“…39 Pantoprazole is an engrained drug used for the treatment of peptic ulcer, which prevents the secretion from the gastric cells and helps in providing relief in GERD. 40 Pantoprazole covalently binds to cysteine residue of proton pump and obstructs the secretion of gastric acid. 41 It inhibits the secretion from gastric cells and helps in effecting consolation in reflux disease and mucosal curing in gastric ulcer and GERD.…”

Inadequate response to proton pump inhibitor therapy: Causes and patient management tactics

“…Одним из доказательств этого служит исследование S. Kunsch и соавт. [34]. Авторы показали, что, несмотря на применение высоких доз ИПН (80 мг пантопразола в день в течение 8 нед), у пациентов с сохраняющимися после лечения жалобами по сравнению с ответившими на терапию отмечается статистически незначимое уменьшение дуоденогастроэзофагеального рефлюкса (ДГЭР).…”

“…Авторы показали, что, несмотря на применение высоких доз ИПН (80 мг пантопразола в день в течение 8 нед), у пациентов с сохраняющимися после лечения жалобами по сравнению с ответившими на терапию отмечается статистически незначимое уменьшение дуоденогастроэзофагеального рефлюкса (ДГЭР). Это может свидетельствовать о том, что у пациентов с ДГЭР терапия только ИПН (даже высокими дозами) не приводит к уменьшению симптомов заболевания и, повидимому, такие больные нуждаются в комбинированной терапии, направленной на улучшение моторики и связывания желчных кислот [34].…”