Proton pump inhibitor step-down therapy for GERD: A multi-center study in Japan

Takao Tsuzuki, Hiroyuki Okada, Yoshiro Kawahara, Ryuta Takenaka, Junichiro Nasu, Hidehiko Ishioka, Akiko Fujiwara, Fumiya Yoshinaga, Kazuhide Yamamoto

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

AIM: To investigate the predictors of success in step down of proton pump inhibitor and to assess the quality of life (QOL). METHODS: Patients who had heartburn twice a week or more were treated with 20 mg omeprazole (OPZ) once daily for 8 wk as an initial therapy (study 1). Patients whose heartburn decreased to once a week or less at the end of the initial therapy were enrolled in study 2 and treated with 10 mg OPZ as maintenance therapy for an additional 6 mo (study 2). QOL was investigated using the gastrointestinal symptom rating scale (GSRS) before initial therapy, after both 4 and 8 wk of initial therapy, and at 1, 2, 3, and 6 mo after starting maintenance therapy. RESULTS: In study 1, 108 patients were analyzed. Their characteristics were as follows; median age: 63 (range: 20-88) years, sex: 46 women and 62 men. The success rate of the initial therapy was 76%. In the patients with successful initial therapy, abdominal pain, indigestion and reflux GSRS scores were improved. In study 2, 83 patients were analyzed. Seventy of 83 patients completed the study 2 protocol. In the per-protocol analysis, 80% of 70 patients were successful for stepdown. On multivariate analysis of baseline demographic data and clinical information, no previous treatment for gastroesophageal reflux disease (GERD) [odds ratio (OR) 0.255, 95% CI: 0.06-0.98] and a lower indigestion score in GSRS at the beginning of step-down therapy (OR 0.214, 95% CI: 0.06-0.73) were found to be the predictors of successful step-down therapy. The improved GSRS scores by initial therapy were maintained through the step-down therapy. CONCLUSION: OPZ was effective for most GERD patients. However, those who have had previous treatment for GERD and experience dyspepsia before stepdown require particular monitoring for relapse.

Original languageEnglish
Pages (from-to)1480-1487
Number of pages8
JournalWorld Journal of Gastroenterology
Volume17
Issue number11
DOIs
Publication statusPublished - Mar 21 2011

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Proton Pump Inhibitors
Gastroesophageal Reflux
Japan
Therapeutics
Omeprazole
Dyspepsia
Heartburn
Odds Ratio
Quality of Life
Abdominal Pain

Keywords

  • Gastroesophageal reflux disease
  • Gastrointestinal symptom rating scale
  • Omeprazole
  • Proton pump inhibitor
  • Step-down therapy

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Proton pump inhibitor step-down therapy for GERD : A multi-center study in Japan. / Tsuzuki, Takao; Okada, Hiroyuki; Kawahara, Yoshiro; Takenaka, Ryuta; Nasu, Junichiro; Ishioka, Hidehiko; Fujiwara, Akiko; Yoshinaga, Fumiya; Yamamoto, Kazuhide.

In: World Journal of Gastroenterology, Vol. 17, No. 11, 21.03.2011, p. 1480-1487.

Research output: Contribution to journalArticle

Tsuzuki, T, Okada, H, Kawahara, Y, Takenaka, R, Nasu, J, Ishioka, H, Fujiwara, A, Yoshinaga, F & Yamamoto, K 2011, 'Proton pump inhibitor step-down therapy for GERD: A multi-center study in Japan', World Journal of Gastroenterology, vol. 17, no. 11, pp. 1480-1487. https://doi.org/10.3748/wjg.v17.i11.1480
Tsuzuki, Takao ; Okada, Hiroyuki ; Kawahara, Yoshiro ; Takenaka, Ryuta ; Nasu, Junichiro ; Ishioka, Hidehiko ; Fujiwara, Akiko ; Yoshinaga, Fumiya ; Yamamoto, Kazuhide. / Proton pump inhibitor step-down therapy for GERD : A multi-center study in Japan. In: World Journal of Gastroenterology. 2011 ; Vol. 17, No. 11. pp. 1480-1487.
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abstract = "AIM: To investigate the predictors of success in step down of proton pump inhibitor and to assess the quality of life (QOL). METHODS: Patients who had heartburn twice a week or more were treated with 20 mg omeprazole (OPZ) once daily for 8 wk as an initial therapy (study 1). Patients whose heartburn decreased to once a week or less at the end of the initial therapy were enrolled in study 2 and treated with 10 mg OPZ as maintenance therapy for an additional 6 mo (study 2). QOL was investigated using the gastrointestinal symptom rating scale (GSRS) before initial therapy, after both 4 and 8 wk of initial therapy, and at 1, 2, 3, and 6 mo after starting maintenance therapy. RESULTS: In study 1, 108 patients were analyzed. Their characteristics were as follows; median age: 63 (range: 20-88) years, sex: 46 women and 62 men. The success rate of the initial therapy was 76{\%}. In the patients with successful initial therapy, abdominal pain, indigestion and reflux GSRS scores were improved. In study 2, 83 patients were analyzed. Seventy of 83 patients completed the study 2 protocol. In the per-protocol analysis, 80{\%} of 70 patients were successful for stepdown. On multivariate analysis of baseline demographic data and clinical information, no previous treatment for gastroesophageal reflux disease (GERD) [odds ratio (OR) 0.255, 95{\%} CI: 0.06-0.98] and a lower indigestion score in GSRS at the beginning of step-down therapy (OR 0.214, 95{\%} CI: 0.06-0.73) were found to be the predictors of successful step-down therapy. The improved GSRS scores by initial therapy were maintained through the step-down therapy. CONCLUSION: OPZ was effective for most GERD patients. However, those who have had previous treatment for GERD and experience dyspepsia before stepdown require particular monitoring for relapse.",
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AU - Takenaka, Ryuta

AU - Nasu, Junichiro

AU - Ishioka, Hidehiko

AU - Fujiwara, Akiko

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N2 - AIM: To investigate the predictors of success in step down of proton pump inhibitor and to assess the quality of life (QOL). METHODS: Patients who had heartburn twice a week or more were treated with 20 mg omeprazole (OPZ) once daily for 8 wk as an initial therapy (study 1). Patients whose heartburn decreased to once a week or less at the end of the initial therapy were enrolled in study 2 and treated with 10 mg OPZ as maintenance therapy for an additional 6 mo (study 2). QOL was investigated using the gastrointestinal symptom rating scale (GSRS) before initial therapy, after both 4 and 8 wk of initial therapy, and at 1, 2, 3, and 6 mo after starting maintenance therapy. RESULTS: In study 1, 108 patients were analyzed. Their characteristics were as follows; median age: 63 (range: 20-88) years, sex: 46 women and 62 men. The success rate of the initial therapy was 76%. In the patients with successful initial therapy, abdominal pain, indigestion and reflux GSRS scores were improved. In study 2, 83 patients were analyzed. Seventy of 83 patients completed the study 2 protocol. In the per-protocol analysis, 80% of 70 patients were successful for stepdown. On multivariate analysis of baseline demographic data and clinical information, no previous treatment for gastroesophageal reflux disease (GERD) [odds ratio (OR) 0.255, 95% CI: 0.06-0.98] and a lower indigestion score in GSRS at the beginning of step-down therapy (OR 0.214, 95% CI: 0.06-0.73) were found to be the predictors of successful step-down therapy. The improved GSRS scores by initial therapy were maintained through the step-down therapy. CONCLUSION: OPZ was effective for most GERD patients. However, those who have had previous treatment for GERD and experience dyspepsia before stepdown require particular monitoring for relapse.

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