Long-term gastroesophageal reflux disease therapy improves reflux symptoms in elderly patients: five-year prospective study in community medicine.
BACKGROUND
Gastroesophageal reflux disease (GERD) impairs the patient's quality of life (QOL), but the effect of long-term maintenance therapy in elderly patients is unknown.


METHODS
We conducted a long-term prospective study. Forty-four GERD patients (11 males; mean age 74 years; QUEST score of at least 6 points) were enrolled in this study. Step-down therapy was selected (proton-pump inhibitor [PPI], histamine-2 receptor antagonist and prokinetic agents for 1 month, respectively). Optimal medication for each patient was continued for 5 years. The efficacy, safety of treatment and reflux symptoms were analyzed. The profiles of the patients who had to continue PPI maintenance therapy were also analyzed.


RESULTS
Reflux symptoms were reduced by the PPI based step-down therapy (baseline 13.8 times/month, after 3.2 times/month, P < 0.001). Reflux symptoms improved in 34 patients (77%). None of the 44 patients had to cease treatment because of side-effects and none experienced any complications during the 5-year period. The prevalence of Helicobacter pylori (Hp) infection in the PPI group (29%, 4/14) was significantly lower (P < 0.01) than in the other treatment group (72%, 21/29). The serum pepsinogen I/II ratio in the PPI treatment group (5.7 +/- 0.5) was significantly higher (P < 0.01) than in the others (4.0 +/- 0.3). The predictive factors for PPI maintenance therapy were Hp-negative status and serum pepsinogen I/II ratio >6.0 (odds ratio 12.0, 95% confidence interval 2.7-54.2).


CONCLUSIONS
Long-term medication for GERD selected on the basis of the patient's profile (i.e. Hp status and gastric atrophy) improved reflux symptoms.
Miyamoto
Masaki
M
Department of General Internal Medicine, Prefectural Hiroshima Hospital, Hiroshima, Japan.
Haruma
Ken
K
Kuwabara
Masao
M
Nagano
Makoto
M
Okamoto
Takeshi
T
Tanaka
Mio
M
D000368:Aged; D001284:Atrophy; D003153:Community Health Services; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005746:Gastric Emptying / Q000187:drug effects*; D005753:Gastric Mucosa / Q000187:drug effects / Q000473:pathology; D005755:Gastrins / Q000097:blood; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006356:Heartburn / Q000188:drug therapy / Q000209:etiology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006635:Histamine H2 Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007564:Japan; D008134:Long-Term Care; D008297:Male; D020116:Pepsinogen A / Q000097:blood; D020115:Pepsinogen C / Q000097:blood; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D017494:Proton Pumps / Q000378:metabolism; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome
D004791:Enzyme Inhibitors; D005755:Gastrins; D005765:Gastrointestinal Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D017494:Proton Pumps; D020115:Pepsinogen C; D020116:Pepsinogen A