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- Title:
High-Dose Esomeprazole for Treatment of Symptomatic Refractory Gastroesophageal Reflux Disease -- A Prospective pH-Metry/Impedance-Controlled Study
- Author(s):
- Bajbouj, Monther; Becker, Valentin; Phillip, Veit; Wilhelm, Dirk; Schmid, Roland M.; Meining, Alexander
- Abstract:
- Background/Aims: Combined pH-metry/multichannel intraluminal impedance (pH/MII) measurement enables to measure gastroesophageal reflux despite ongoing proton pump inhibitor therapy. The aim of our study was to evaluate the influence of an escalating medical anti-reflux therapy with 40 mg esomeprazole, 80 mg esomeprazole and 80 mg esomeprazole plus baclofen for the treatment of refractory pathological reflux as determined by pH/MII. Methods: Symptomatic patients under 40 mg esomeprazole were screened by pH/MII. Patients with normal values in pH/MII were excluded; all others received 2 × 40 mg esomeprazole for another 4 weeks. Thereafter, the treatment effect was controlled by pH/MII. In the case of persistent pathological reflux, therapy was further escalated by adding baclofen and controlled after 3 months by pH/MII. Results: 45/138 (32.6%) patients showed pathological pH/MII despite ongoing therapy with 40 mg esomeprazole. In these, a significant reduction in liquid/mixed reflux events was observed after administering 2 × 40 mg (mean: 118.3 vs. mean: 66.6; p < 0.001), and pH/MII turned to normal in 32/45 (71.1%). Baclofen was additionally administered to 7/13 patients, which did not lead to a remarkable reduction in reflux events. Conclusion: In patients with abnormal pH/MII and persistent symptoms under 40 mg esomeprazole, we observed a significant reduction in liquid/mixed reflux events after increasing proton pump inhibitor dose up to 80 mg esomeprazole. Further escalation of therapy with baclofen has shown inconclusive results.
- Keywords:
- Reflux; Gastroesophageal reflux disease; Proton pump inhibitors; Baclofen; Impedance monitoring; Esomeprazole
- Journal title:
- Digestion
- Year:
- 2009
- Journal volume:
- 80
- Journal issue:
- 2
- Pages contribution:
- 112--118
- Fulltext / DOI:
- doi:10.1159/000221146
- Publisher:
- S. Karger AG
- Publisher address:
- Basel, Switzerland
- Print-ISSN:
- 1421-9867
- E-ISSN:
- 1421-9867
- Notes:
- Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich. This publication is with permission of the rights owner freely accessible due to an Alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively.
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