Systematic review: proton‐pump inhibitor failure in gastro‐oesophageal reflux disease – where next?

Fass, Ronnie; Shapiro, Michael; Dekel, Roy; Sewell, Justin L.

doi:10.1111/j.1365-2036.2005.02531.x

Cited by 348 publications

(360 citation statements)

References 80 publications

(60 reference statements)

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“…100 However, there is a discrepancy in BE between symptom resolution and control of intraesophageal acid exposure. 101 Studies with ambulatory 24-hour esophageal pH monitoring revealed that 20-80 % of symptomatically controlled BE patients continued to demonstrate some level of abnormal acid exposure, suggesting that these patients may be undertreated. 102,103 Interestingly this phenomenon has been described even when high doses of PPI (up to 4 times daily) have been used.…”

Section: Barrett's Esophagusmentioning

confidence: 99%

Unmet Needs in the Treatment of Gastroesophageal Reflux Disease

Dickman

Maradey–Romero

Gingold‐Belfer

et al. 2015

J Neurogastroenterol Motil

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Gastroesophageal reflux disease (GERD) is a highly prevalent gastrointestinal disorder. Proton pump inhibitors have profoundly revolutionized the treatment of GERD. However, several areas of unmet need persist despite marked improvements in the therapeutic management of GERD. These include the advanced grades of erosive esophagitis, nonerosive reflux disease, maintenance treatment of erosive esophagitis, refractory GERD, postprandial heartburn, atypical and extraesophageal manifestations of GERD, Barrett's esophagus, chronic protein pump inhibitor treatment, and post-bariatric surgery GERD. Consequently, any future development of novel therapeutic modalities for GERD (medical, endoscopic, or surgical), would likely focus on the aforementioned areas of unmet need.

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Section: Barrett's Esophagusmentioning

confidence: 99%

Unmet Needs in the Treatment of Gastroesophageal Reflux Disease

Dickman

Maradey–Romero

Gingold‐Belfer

et al. 2015

J Neurogastroenterol Motil

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“…Th is is in contrast to the response of erosive esophagitis patients receiving anti-refl ux treatment ( 25 ). During the last 7 days of the study, 48 and 70 % of patients receiving dexlansoprazole MR reported relief of nocturnal heartburn and GERD-related sleep disturbances, respectively, which were signifi cantly greater than with placebo ( P < 0.001 for each comparison).…”

Section: Esophagusmentioning

confidence: 88%

The Effect of Dexlansoprazole MR on Nocturnal Heartburn and GERD-Related Sleep Disturbances in Patients With Symptomatic GERD

Fass

Johnson

Orr

et al. 2011

American Journal of Gastroenterology

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Approximately 14 -20 % of US adults experience gastroesophageal refl ux disease (GERD) weekly ( 1,2 ), which translates to more than 60 million adults ( 3 ). Among those reporting GERD symptoms, up to 89 % report nocturnal symptoms ( 1,4 -6 ), resulting in impairment in health-related quality of life (HRQoL) and signifi cantly worse sleep quality ( 7,8 ). Because continued sleep disruption leads to increased daytime sleepiness ( 9 ), nocturnal heartburn can reduce productivity while patients are present at work, as well as reduce function when performing normal daily activities ( 7,8,10,11 ). Th e continued presence of nocturnal heartburn despite routine medical treatment is strongly associated with decreases in HRQoL ( 12 ). In addition, the majority of GERD patients participating in a Gallup survey were not completely satisfi ed with their over-the-counter or prescription medication due to persistent nocturnal symptoms ( 6 ).Th e aims of this study were to assess, in patients with symptomatic GERD, the effi cacy and safety of dexlansoprazole MR 30 mg Nocturnal heartburn and related sleep disturbances are common among patients with gastroesophageal refl ux disease (GERD). This study evaluated the effi cacy of dexlansoprazole MR 30 mg in relieving nocturnal heartburn and GERD-related sleep disturbances, improving work productivity, and decreasing nocturnal symptom severity in patients with symptomatic GERD. METHODS:Patients ( N = 305) with frequent, moderate-to-very severe nocturnal heartburn and associated sleep disturbances were randomized 1:1 in a double-blind fashion to receive dexlansoprazole MR or placebo once daily for 4 weeks. The primary end point was the percentage of nights without heartburn. Secondary end points were the percentage of patients with relief of nocturnal heartburn and of GERD-related sleep disturbances over the last 7 days of treatment. At baseline and week 4 / fi nal visit, patients completed questionnaires that assessed sleep quality, work productivity, and the severity and impact of nocturnal GERD symptoms. RESULTS:Dexlansoprazole MR 30 mg ( n = 152) was superior to placebo ( n = 153) in median percentage of nights without heartburn (73.1 vs. 35.7 % , respectively; P < 0.001). Dexlansoprazole MR was signifi cantly better than placebo in percentage of patients with relief of nocturnal heartburn and GERD-related sleep disturbances (47.5 vs. 19.6 % , 69.7 vs. 47.9 % , respectively; P < 0.001), and led to signifi cantly greater improvements in sleep quality and work productivity and decreased nocturnal symptom severity. Adverse events were similar across treatment groups.CONCLUSIONS: In patients with symptomatic GERD, dexlansoprazole MR 30 mg is signifi cantly more effi cacious than placebo in providing relief from nocturnal heartburn, in reducing GERD-related sleep disturbances and the consequent impairments in work productivity, and in improving sleep quality / quality of life.SUPPLEMENTARY MATERIAL is linked to the online version of the paper at

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“…There remains a substantial group of patients that do not respond to therapy. It is believed that psychosocial factors and abnormalities of gut function play a role in the manifestation and severity of symptoms [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

“…Refractory GERD is defined as partial response or lack of response in GERD patients taking PPI twice daily over a period of at least 3 months. It has been estimated that between 10% and 40% of GERD patients fail to respond symptomatically, either partially or completely, to a standard-dose PPI [1] (Figure 2). Currently, this disorder is the most common presentation of GERD in gastroenterology practice.…”

Section: Introductionmentioning

confidence: 99%

Anxiety Induced Refractory Gastrointestinal Disorders

Faruqui¹

2017

JLRDT

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Million suffer from acid related disorders with little respite without treatment. Today progress made has given us a quantum leap in understanding the disease and this has translated into the development of effective treatment. Right from the use of antacids which dominated the treatment arena in the last century to the discovery of Histamine-2-receptor antagonists towards the second half of the last century, progress has been constant over the decades. Today the benefits of the PPIs (proton pump inhibitors) have percolated to countless people across the globe. At no point in history were acid disorders this effectively managed. Furthermore, the relationship between anxiety and heartburn is not an obvious one. Many of the patients that suffer from heartburn when they have anxiety already had GERD (gastroesophageal reflux disorder). However, GERD patients with psychological comorbidity tend to seek medical assistance for their acid reflux earlier than patients without comorbidity, probably due to anxiety, concern over painful symptoms and depression, prompting scientist to dwell on the approach forward. Lead by observations that are based on recent data about the contribution of psychological comorbidity to the PPI failure phenomenon, GERD patients who are not responsive to treatment should be evaluated for psychological comorbidity.Keywords: Histamine-2-receptor; GERD patients; PPI; Inflammatory reactions; Clinical condition

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Systematic review: proton‐pump inhibitor failure in gastro‐oesophageal reflux disease – where next?

Cited by 348 publications

References 80 publications

Unmet Needs in the Treatment of Gastroesophageal Reflux Disease

Unmet Needs in the Treatment of Gastroesophageal Reflux Disease

The Effect of Dexlansoprazole MR on Nocturnal Heartburn and GERD-Related Sleep Disturbances in Patients With Symptomatic GERD

Anxiety Induced Refractory Gastrointestinal Disorders

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