Observational comparative trial of the efficacy of proton pump inhibitors versus histamine-2 receptor antagonists for uninvestigated dyspepsia.
OBJECTIVE
It is still controversial which drugs, proton pump inhibitors (PPI) or histamine-2 receptor antagonists (H2RA), are more effective for dyspepsia in the Japanese population.


METHODS
Patients with uninvestigated dyspepsia (n = 104; male/female 41/63) were treated with either rabeprazole 10 mg o.d. (n = 62) or lafutidine 10 mg b.i.d. (n = 42) for 4 weeks. Questionnaires (modified Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease [mFSSG] and quality of life [QOL], SF-8) were administered before and after therapy. The mFSSG was classified into a total score (Q-T), reflux score (Q-R), dyspepsia score (Q-D) and pain score (Q-P). The SF-8 had a physical component summary (PCS) and mental component summary (MCS). The predominant type of symptom was reflux (R-S), pain (P-S) or dysmotility (D-S).


RESULTS
R-S was 19.2%, P-S 48.1%, D-S 24.0% and overlap 8.7%. In the R-S, Q-T and Q-R significantly improved with rabeprazole, but neither scale improved with lafutidine. MCS significantly improved with rabeprazole. In P-S, Q-T, Q-R, Q-D and Q-P significantly improved with both drugs. PCS significantly improved with both, whereas the MCS significant improved with rabeprazole. In D-S, Q-R and Q-D significant improved with rabeprazole, but neither improved with lafutidine. QOL did not improve with either. With overlap, neither scale nor the QOL reached a significant difference.


CONCLUSIONS
Both PPI and H2RA have a positive effect on P-S, but H(2)RA therapy is limited for R-S and D-S, whereas PPI therapy is generally effective. Therefore, careful prescription based on symptoms is important.
Nagahara
Akihito
A
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan. nagahara@juntendo.ac.jp
Asaoka
Daisuke
D
Hojo
Mariko
M
Oguro
Masako
M
Shimada
Yuji
Y
Ishikawa
Dai
D
Osada
Taro
T
Kawabe
Masato
M
Yoshizawa
Takashi
T
Otaka
Michiro
M
Watanabe
Sumio
S
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use*; D000081:Acetamides / Q000627:therapeutic use*; D000328:Adult; D004415:Dyspepsia / Q000150:complications / Q000188:drug therapy*; D015154:Esophageal Motility Disorders / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000209:etiology; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010147:Pain Measurement; D010880:Piperidines / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D011725:Pyridines / Q000627:therapeutic use*; D064750:Rabeprazole; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000081:Acetamides; D006635:Histamine H2 Antagonists; D010880:Piperidines; D054328:Proton Pump Inhibitors; D011725:Pyridines; D064750:Rabeprazole; C076948:lafutidine