title: Gastroesophageal reflux disease in intellectually disabled individuals: leads for diagnosis and the effect of omeprazole therapy.
abstract: OBJECTIVE
  The therapeutic approach to gastroesophageal reflux disease (GERD) in intellectually disabled individuals has not been studied extensively. So far, only low response rates to medical and surgical therapy of GERD have been reported. However, the efficacy of proton pump inhibitors, to date the most effective medical therapy for GERD, has never been evaluated in this population. Our purpose, therefore, was to study the effect of omeprazole on healing and symptom relief in the intellectually disabled.
  
  
  METHODS
  The treatment scheme was as follows: omeprazole 40 mg was given once daily (o.d.) as a healing dose for 3 months, and omeprazole 20 mg o.d. was given as a maintenance dose for another 3 months, to intellectually disabled subjects with endoscopically proven esophagitis, grades I-IV, according to Savary-Miller classification. After 3 and 6 months, the result of this treatment was evaluated by symptom scoring and/or endoscopy. In case of relapse, the dose was increased.
  
  
  RESULTS
  At the first endoscopy, 40 of 107 patients (37%) had grade I, 36 (34%) grade II, 18 (17%) grade III, and 13 (12%) grade IV esophagitis. In 92 of 104 patients (88%), the treatment scheme was effective in healing the esophagitis and keeping patients in remission, independent of the severity of esophagitis. In 11 of 104 (11%) patients, a symptomatic relapse was observed after the dose was decreased to 20 mg o.d. However, all of these patients became symptom free again after the dose was increased to 40 mg o.d., and all were healed endoscopically at the end of the study. One (1%) patient needed omeprazole 60 mg o.d. for healing, but in this patient, no relapse was seen while on a maintenance dose of omeprazole 40 mg o.d. Marked improvement of persistent vomiting, hematemesis, regurgitation, food refusal, iron deficiency anemia, and depressive symptoms was seen at the end of the study.
  
  
  CONCLUSIONS
  This study indicates that omeprazole is highly effective for all grades of esophagitis in the intellectually disabled. The dose needed to maintain them in remission can be titrated according to the reflux symptoms.
authors.affiliation: Bartiméus Center for Visually Handicapped/Visually and Intellectually Handicapped, Zeist, The Netherlands.
authors.forename: C J
authors.initials: CJ
authors.lastname: Bohmer
authors.forename: M C
authors.initials: MC
authors.lastname: Niezen-de Boer
authors.forename: E C
authors.initials: EC
authors.lastname: Klinkenberg-Knol
authors.forename: H A
authors.initials: HA
authors.lastname: Tuynman
authors.forename: J H
authors.initials: JH
authors.lastname: Voskuil
authors.forename: W L
authors.initials: WL
authors.lastname: Devillé
authors.forename: S G
authors.initials: SG
authors.lastname: Meuwissen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000517:prevention & control; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003863:Depression / Q000517:prevention & control; D004334:Drug Administration Schedule; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D004942:Esophagitis, Peptic / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy; D001068:Feeding and Eating Disorders / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control; D006396:Hematemesis / Q000517:prevention & control; D006801:Humans; D008607:Intellectual Disability; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors; D012008:Recurrence; D012074:Remission Induction; D014839:Vomiting / Q000517:prevention & control; D014945:Wound Healing
chemical_list: D000897:Anti-Ulcer Agents; D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D009853:Omeprazole