Regurgitation Is Less Responsive to Acid Suppression Than Heartburn in Patients With Gastroesophageal Reflux Disease
Clinical Gastroenterology and Hepatology ,
Kahrilas PJ et al. – Regurgitation was less responsive to acid suppression than heartburn in patients with gastroesophageal reflux disease, indicating that persistent regurgitation is a common cause of incomplete treatment response.Methods
- The authors analyzed data from 2 randomized controlled trials of AZD0865 (a potassium-competitive acid blocker) 25-75 mg/day vs esomeprazole 20-40 mg/day for the treatment of nonerosive reflux disease (NERD, n=1460) or reflux esophagitis (RE, n=1514).
- Inclusion criteria for both studies were high-severity substernal burning (≥4 days per week of at least moderate intensity) during the week before enrollment.
- Pooled data from all treatment arms were used to ascertain the response of the reflux disease questionnaire regurgitation items to potent acid suppression during the fourth week of treatment.
- When the study began, 93% of patients with NERD or RE had either “acid taste in the mouth” (regurgitation-taste) or “unpleasant movement of material upwards from the stomach” (regurgitation-movement).
- Either or both symptoms were present and severe in 53% of NERD (n=717) and 54% of RE patients (n=751) for the main study outcome.
- During week 4 of therapy, patients with severe “regurgitation-taste” and “regurgitation-movement” responded significantly less well than patients with NERD and high severity “substernal burning” (34% and 26% vs 49%) or those with RE (44% and 33% vs 55%).
- There were no differences in symptom response between patients with healed and nonhealed RE.