Influence of gastric mucosal status on success of stepwise acid suppressive therapy for dyspepsia.
BACKGROUND
The most effective initial treatment strategy of dyspepsia is still under debate. Individual biological characteristics, such as condition of gastric mucosa, might contribute to selection of the most appropriate acid suppression treatment strategy.


OBJECTIVE
To assess whether pre-treatment testing of gastric mucosal status is relevant for treatment success in an RCT comparing step-up and step-down therapies in newly diagnosed dyspepsia patients.


METHODS
Baseline serum samples were collected to assess gastric mucosal status using serum levels of pepsinogens-I&II, gastrin-17, and Helicobacter pylori IgA/IgG-antibodies. The 6-month treatment success was compared between step-up and step-down for patients with serum diagnoses: normal; gastritis; corpus atrophy or antrum atrophy.


RESULTS
In all, 519 patients (M/F: 249/270, age: 47 (18-85) years, 29%H. pylori+) were randomized to step-up (n = 293) or step-down (n = 226). Normal mucosa, gastritis and corpus atrophy were diagnosed serologically in 70%, 28% and 2% of the patients, evenly distributed between the strategies (P = 0.65). Treatment success was achieved in respectively, 69%, 70% and 70% for the serum diagnosis groups, and did not differ between the strategies.


CONCLUSIONS
Dyspepsia treatment success could not be predicted by gastric mucosal status. Therefore, serum diagnosis of gastric mucosal status is no useful tool for patient allocation to acid suppressive treatment strategies.
van Marrewijk
C J
CJ
Department of Gastroenterology & Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. c.vanmarrewijk@antrg.umcn.nl
van Oijen
M G H
MG
Paloheimo
L I
LI
Fransen
G A J
GA
Mujakovic
S
S
Muris
J W M
JW
Numans
M E
ME
De Wit
N J
NJ
Grobbee
D E
DE
Knottnerus
J A
JA
Laheij
R J F
RJ
Jansen
J B M J
JB
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D000906:Antibodies / Q000097:blood; D003657:Decision Making; D004311:Double-Blind Method; D004415:Dyspepsia / Q000188:drug therapy* / Q000276:immunology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010435:Pepsinogens / Q000097:blood; D010821:Physicians, Family; D016896:Treatment Outcome; D055815:Young Adult
D000897:Anti-Ulcer Agents; D000906:Antibodies; D010435:Pepsinogens