| Concomitant irritable bowel syndrome is associated with failure of step-down on-demand proton pump inhibitor treatment in patients with gastro-esophageal reflux disease. | |
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MedLine Citation:
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PMID: 21087355 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The predictors for treatment failure of on-demand proton pump inhibitor (PPI) therapy in gastro-esophageal reflux disease (GERD) patients are unclear. We studied the efficacy and predictors for treatment failure of step-down on-demand PPI therapy in patients with non-erosive reflux disease (NERD) and those with low grade erosive esophagitis. METHODS: Consecutive symptomatic GERD patients who had positive esophageal pH studies and complete symptom resolution with initial treatment of esomeprazole were given step-down on-demand esomeprazole for 26 weeks. Patients with esophagitis of Los Angeles (LA) grade C or above and recent use of PPI were excluded. Treatment failure was defined as an inadequate relief of reflux symptoms using global symptom assessment. Potential predictors of treatment failure were determined using multivariate analysis. KEY RESULTS: One hundred and sixty three NERD and 102 esophagitis patients were studied. The 26-week probability of treatment failure was 36.2% (95% CI: 23.9-46.5%) in NERD group and 20.1% (95% CI: 10.9-28.3%) in esophagitis group, respectively (P = 0.021). Irritable bowel syndrome (adjusted HR: 2.1, 95% CI: 1.5-3.8, P = 0.01), in addition to daily reflux symptom (adjusted hazard ratio: 2.7, 95% CI: 1.9-4.2, P = 0.001) and concomitant dyspepsia (adjusted hazard ratio: 1.7, 95% CI: 1.1-2.8, P = 0.04), were independent predictors for treatment failure. CONCLUSIONS & INFERENCES: Compared to patients with esophagitis, NERD patients have higher failure rate of on-demand PPI therapy. Concomitant irritable bowel syndrome, in addition to daily reflux symptom and dyspepsia, is associated with the failure of on-demand PPI in these patients. |
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Authors:
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J C Y Wu; L H Lai; D K L Chow; G L H Wong; J J Y Sung; F K L Chan |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't Date: 2010-11-19 |
Journal Detail:
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Title: Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society Volume: 23 ISSN: 1365-2982 ISO Abbreviation: Neurogastroenterol. Motil. Publication Date: 2011 Feb |
Date Detail:
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Created Date: 2011-01-13 Completed Date: 2011-06-17 Revised Date: 2011-09-01 |
Medline Journal Info:
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Nlm Unique ID: 9432572 Medline TA: Neurogastroenterol Motil Country: England |
Other Details:
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Languages: eng Pagination: 155-60, e31 Citation Subset: IM |
Copyright Information:
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© 2010 Blackwell Publishing Ltd. |
Affiliation:
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Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong. justinwu@cuhk.edu.hk |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Cohort Studies Comorbidity Esophagitis, Peptic / drug therapy, epidemiology Female Gastroesophageal Reflux / drug therapy*, epidemiology* Humans Hydrogen-Ion Concentration Irritable Bowel Syndrome / epidemiology* Longitudinal Studies Male Manometry Middle Aged Multivariate Analysis Omeprazole / therapeutic use* Predictive Value of Tests Prospective Studies Proton Pump Inhibitors / therapeutic use* Retrospective Studies Treatment Failure |
| Chemical | |
Reg. No./Substance:
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0/Proton Pump Inhibitors; 73590-58-6/Omeprazole |
| Comments/Corrections | |
Comment In:
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Neurogastroenterol Motil. 2011 Aug;23(8):811
[PMID:
21762283
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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