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The early therapeutic response at 2 weeks is a crucial predictor of proton pump inhibitor-refractory gastroesophageal reflux disease

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A Correction to this article was published on 08 April 2021

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Abstract

Background

In recent years, the prevalence of proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease (GERD) has been increasing, posing a clinical obstacle to improving the management of GERD patients. The ability of known predictive factors to explain therapeutic response to PPI remains insufficient. Therefore, we examined whether the addition of early therapeutic response to PPI as an explanatory variable may increase the predictive power for PPI-refractory GERD.

Methods

The severity and therapeutic response of GERD symptoms to PPI were evaluated using the GastroEsophageal Reflux and Dyspepsia Therapeutic Efficacy and Satisfaction Test (GERD-TEST) questionnaire at baseline and at 2 and 4 weeks after treatment. The relevance of the therapeutic effect of PPI at 2 weeks compared to that at 4 weeks was examined in 301 patients with GERD. Independent predictive factors for refractory GERD at 4 weeks of PPI therapy were examined in 182 patients. The effect of various clinical factors, including the early response to PPI, was assessed using multiple regression analysis.

Results

The number of PPI-therapy responders increased significantly with the duration of treatment (p < 0.0001). The response to PPI therapy at 2 weeks was significantly correlated with that at 4 weeks (p < 0.0001). Multiple regression analysis revealed that the therapeutic response to PPI at 2 weeks was by far the strongest predictor of the therapeutic effect at 4 weeks among all clinical factors.

Conclusions

Medication change for PPI-refractory GERD at 2 weeks may be an efficacious therapeutic strategy to improve patients’ quality of life.

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Acknowledgements

The authors are grateful to the GERD Society (Osaka, Japan) for their support of this clinical study. We would like to thank the patients and all physicians who participated in this study.

Funding

Financial support for this clinical study was provided by GERD Society (Osaka, Japan).

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan

    Maiko Ogawa, Seiji Arihiro, Tatsuya Nakada & Atsushi Hokari

  2. Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan

    Nobuyuki Matsuhashi

  3. Gamagori City Hospital, Aichi, Japan

    Takashi Joh

  4. Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan

    Kazuhide Higuchi

  5. Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan

    Katsuhiko Iwakiri

  6. Department of Medical Innovation, Nagoya City University Graduate School Medical Sciences, Nagoya, Japan

    Takeshi Kamiya

  7. Division of Endoscopy and Ultrasonography, Department of Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan

    Noriaki Manabe

  8. Isshi Gastro-Intestinal Clinic, Tokyo, Japan

    Kimio Isshi

  9. Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan

    Masayuki Saruta

  10. Faculty of Letters, Arts and Sciences, Waseda University, Tokyo, Japan

    Atsushi Oshio

  11. Department of General Internal Medicine 2, Kawasaki Medical School Kawasaki Hospital, Okayama, Japan

    Ken Haruma

  12. Department of Laboratory Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan

    Koji Nakada

Authors
  1. Maiko Ogawa
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  2. Seiji Arihiro
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  3. Nobuyuki Matsuhashi
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  4. Takashi Joh
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  5. Kazuhide Higuchi
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  6. Katsuhiko Iwakiri
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  7. Takeshi Kamiya
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  8. Noriaki Manabe
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  9. Kimio Isshi
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  10. Tatsuya Nakada
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  11. Atsushi Hokari
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  12. Masayuki Saruta
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  13. Atsushi Oshio
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  14. Ken Haruma
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  15. Koji Nakada
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Contributions

The contributors from each institution are listed below: NM: NTT Medical Center Tokyo; MK: Sapporo Hokuyu Hospital; NY and TS: Japanese Red Cross Kyoto Daiichi Hospital; KM and SS: Oita University Faculty of Medicine; MK and KM: Hokkaido University Hospital; TS and JH: Kita Harima Medical Center; NM and KH: Kawasaki Medical School; YN and OH: Kyoto Prefectural University of Medicine; SI: National Hospital Organization Kochi Hospital; HO and YI: Matsushita Memorial Hospital; SM: Tomakomai City Hospital; KF and SO: Shimane University Faculty of Medicine; TO and HM: Hyogo College of Medicine; YF and YK: Osaka City University Graduate School of Medicine; KM and YS: Tenjin Clinic, Medical Corporation Shinai; YI and SO: Shinshu University School of Medicine; TA and YK: Takarazuka Municipal Hospital; HM: Toyama City Hospital; KI, Isshi Gastro-Intestinal Clinic; HS and TC, Kyoto University Hospital; FK and MN, University Hospital, University of the Ryukyus; TS and HF, University of Toyama; KU, Aichi Medical University Medical Clinic; HK and TM, Gunma University Hospital; Noriko Watanabe, National Hospital Organization Mie Chuo Medical Center; FK and KY: Sanuki Municipal Hospital; TI and HF: Shimane Prefectural Central Hospital; TY and YK: Teikyo University School of Medicine; and YN and KK: Tokyo Medical and Dental University.

Corresponding author

Correspondence to Koji Nakada.

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Ethical Statement

The study was conducted in accordance with the Declaration of Helsinki (sixth revision, 2008), after approval by the ethics committee of each institution or the central ethics committee of Nishi Clinic, Osaka, Japan.

Conflict of interest

Dr. Nobuyuki Matsuhashi received a research grant from Astrazeneca, Takeda Pharm., Eizai. Dr. Katsuhiko Iwakiri received Lecture fees from Takeda Pharmaceutical Co., Ltd., Otsuaka Pharmaceutical Co., Ltd., DAIICHI SANKYO COMPANY, LIMITED, and EA Pharma Co., LTD. Dr. Maiko Ogawa, Dr. Seiji Arihiro, Dr. Takashi Joh, Dr. Kazuhide Higuchi, Dr. Takeshi Kamiya, Dr. Noriaki Manabe, Dr. Kimio Isshi, Dr. Tatsuya Nakada, Dr. Atsushi Hokari, Dr. Masayuki Saruta, Dr. Atsushi Oshio, Dr. Ken Haruma and Dr. Koji Nakada declare that they have no conflict of interest.

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Written informed consent was obtained from all enrolled patients.

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Ogawa, M., Arihiro, S., Matsuhashi, N. et al. The early therapeutic response at 2 weeks is a crucial predictor of proton pump inhibitor-refractory gastroesophageal reflux disease. Esophagus 18, 398–406 (2021). https://doi.org/10.1007/s10388-020-00792-z

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  • DOI: https://doi.org/10.1007/s10388-020-00792-z

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