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Unresolved Upper Gastrointestinal (UGI) and Extraesophageal (EE) Symptoms in Gastroesophageal Reflux Disease (GERD) Patients Despite Chronic Proton Pump Inhibitor (PPI) Therapy

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Earnest, D., M.D.; Lembo, A., M.D.; Novick, J., M.D.; Proskin, H., M.D.; Rojavin, M., M.D.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S48–S49
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
Free

Novartis Pharmaceuticals Corp, East Hanover, NJ; Beth Israel Deaconess Medical Center, Boston, MA; Charm City Research, Towson, MD and HM Proskin & Associates, Rochester, NY.

Purpose: PPIs are the most effective agents for treatment of GERD and related complications. However, 30% or more of patients with GERD do not have complete relief of heartburn (HB) with PPIs (Richter et al, 2000) and an unknown potentially greater number fail to gain relief of other associated symptoms. We have studied GERD patients with incomplete relief of HB to define the spectrum of persisting bothersome symptoms.

Methods: Male (M) or female (F) patients were included if they: were ≥18 years; treated for a physician-made diagnosis of GERD with therapeutic doses of PPI for ≥8 weeks prior to study entry; had incomplete relief of GERD-related symptoms HB and regurgitation (RG) and reported HB at least 3 days/week with at least moderate HB 1x/week during the 3 weeks preceding study entry. During baseline, patients were asked about frequency (days/week), severity (6-grade scale), and bothersomeness (5-grade scale) of 14 symptoms associated with GERD.

Results: 98 GERD patients (39 M, 59 F, age 50.4 ± 12.6 [M ± SD] years) qualified. All (100%) reported HB and RG. Belching was reported by 79%, upper abdominal discomfort −72%, bloating −66%, excessive postmeal fullness −65%, chest pain −62%, epigastric pain −58%, fullness during meal −58%, hoarseness −47%, cough after meal or at night −45%, nausea −43%, dysphagia −38%, and emesis −12%. PPI use was 1x daily for 76% and 2x daily for 24% of patients. As expected, HB was the most severe symptom (score 3.46 ± 1.11). However, severity of other symptoms was also prominent: belching (2.53 ± 1.60), upper abdominal discomfort (2.44 ± 1.70), bloating (2.42 ± 1.99), and postmeal fullness (2.20 ± 1.95). Top scores for bothersomeness: HB (3.20 ± 1.04), belching and upper abdominal discomfort (2.21 ± 1.49 and 2.21 ± 1.54, respectively), bloating (2.20 ± 1.78), RG and chest pain (1.97 ± 1.61 and 1.97 ± 1.70, respectively).

Conclusions: Despite chronic PPI therapy, some GERD patients do not gain symptom resolution and continue to be bothered by a variety of “classic GERD” (HB, RG, dysphagia), dyspeptic (belching, fullness, bloating, abdominal discomfort) and EE (hoarseness, cough) symptoms. Further study of the cause for these symptoms is indicated. An additional approach to GERD treatment is needed to give more complete relief from significant persisting symptoms.

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