Management of symptoms in step-down therapy of gastroesophageal reflux disease.
OBJECTIVE
Majority of studies on gastroesophageal reflux disease (GERD) that include patients with or without erosive disease have documented the efficacy of proton pump inhibitors (PPIs) as well as their superiority to H(2)-receptor antagonist (H(2)-RA). The purpose of this study was to clarify the difference in quality of GERD treatment with PPIs and H(2)-RA in step-down protocol using lansoprazole.


METHODS
Forty-three patients with reflux esophagitis were randomly divided into three groups and assessed by severity score; group 1 received 30 mg lansoprazole initially and maintenance therapy with a standard dose H(2)-RA; group 2 received 30 mg of lansoprazole initially and maintenance therapy of 15 mg lansoprazole; and group 3 received 15 mg of lansoprazole once daily for 16 weeks. If the patients experienced symptomatic recurrence while on H(2)-RA, they were switched to PPI maintenance.


RESULTS
Heartburn, regurgitation and dysphagia were hardly found in any group at 8 weeks after 15 mg or 30 mg lansoprazole treatment. After 8 weeks, however, heartburn and regurgitation recurred at 50% and 78.6%, respectively, in the stepped down to famotidine group, and quality of life (QOL) was significantly impaired. Endoscopic ultrasonography (EUS) analysis showed reduction of the submucosal layer without any change in the mucosal surface in the stepped down to famotidine group.


CONCLUSIONS
Step-down lansoprazole therapy is considered very effective in terms of rapid effect, long-term effect and high quality GERD treatment.
Mine
Shinichiro
S
Department of Internal Medicine, Nakama Municipal Hospital, Japan. s-mine@med.uoeh-u.ac.jp
Iida
Takeshi
T
Tabata
Takahiro
T
Kishikawa
Hirofumi
H
Tanaka
Yoshiya
Y
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000368:Aged; D003680:Deglutition Disorders / Q000188:drug therapy; D019160:Endosonography; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D004942:Esophagitis, Peptic / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D015738:Famotidine / Q000627:therapeutic use; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006356:Heartburn / Q000188:drug therapy; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000031:analogs & derivatives* / Q000627:therapeutic use; D054328:Proton Pump Inhibitors; D011788:Quality of Life; D012008:Recurrence; D016896:Treatment Outcome
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D004791:Enzyme Inhibitors; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D015738:Famotidine; D009853:Omeprazole