reflux and acid-related dyspepsia scores were seen in the RPZ group before and after ondemand therapy. Conclusion: On-demand PPI therapy, especially with RPZ, is effective for maintaining symptomatic control in Japanese patients with erosive GERD.
M1919 Nocturnal Gastric Acid Suppression Is Better Achieved with the Addition of a Nighttime H2-Receptor Antagonist Solomon Dawson, Nasser Hajar, Richard Rackett, Amine Hila
Background: The effectiveness of standard PPI therapy on nocturnal acid breakthrough and nighttime reflux symptoms is suboptimal. The addition of an H2-receptor antagonist (H2RA) to PPI therapy provides better control of gastric acid production during recumbency. Nocturnal acid breakthrough, defined as a gastric pH < 4 for a minimum of 60 minutes at night, is of importance because during recumbency, there is reduced esophageal clearing. Aim: To determine the effect of adding an H2RA at bedtime to once or twice a day PPI therapy on gastric acid production. Methods: 115 consecutive multichannel intraluminal impedance and pH studies performed from 11/06 to 09/08 were reviewed (86 females; Median age 50 years; range: 14 - 82 years). The time and % time gastric pH < 4 while upright, recumbent and total were recorded. Therapeutic regimens included PPI once a day (QD), PPI twice a day (BID), PPI twice a day (BID) plus an H2RA at night (QHS), and no therapy. Results: 8 subjects were on no therapy, 19 on PPI QD, 39 on PPI BID, and 49 on PPI BID plus H2RA QHS. When comparing PPI BID plus H2RA QHS versus PPI QD, PPI BID, and no therapy, we found that it afforded a significantly better control of nighttime gastric acid production (P < 0.01, Mann - Whitney test; P < 0.0001 ANOVA). Mean % time gastric pH < 4 during recumbency was: 23.5%, 57.3%, 42.0%, and 82.4% respectively, for each therapeutic option. There was no significant difference in % time pH < 4 while upright between PPI QD, PPI BID, and PPI BID plus H2RA QHS. Mean % time pH < 4 for the upright position was: 38.8%, 37.7%, and 30.6% respectively (P = 0.467 ANOVA). Conclusions: The addition of H2RA therapy at night to PPI therapy allows significantly better suppression of gastric acid production during recumbency. However the addition of the H2RA at night does not have a significant effect on daytime gastric acid production.
The Quality of Life in the Patients with GERD At 2~3yrs' Follow Up After 52ws Rabeprazole Treatment Xiaohong Liu, Xilin Yang, Meiyun Ke Background GERD is a chronic disease that has negative impacts on quality of life(QoL). 52-week Raberprazole treatment was demonstrated to be effective on improving the reflux symptoms as well as QoL in GERD patients in our previous study. Objectives To investigate the QoL of GERD patients at 2~3yrs' follow up after 52-week PPI treatment. Methods 70 EE and 33 NERD patients had finished a multi-centre, open, randomized 52-week Raberprazole treatment. After 2~3yrs' follow up, the QoL was evaluated by using SF-36 Health Survey Questionnaire and GERD-HRQL scale. The results were compared with those acquired before the 52-week treatment. Results 42 EE and 21 NERD cases were investigated at 2~3yrs'follow up after Raberprazole treatment. (1). Comparing with the pre-therapy baseline, for EE there was no significant difference in the mean subscales of SF-36(P=0.175), however, EE had significant improvement in the domain of vitality (P=0.046). For NERD the tendency of having higher mean subscales of SF-36 was observed(P=0.087), particularlly in the domain of emotion(P=0.035). The scales of reflux symptoms and overall satisfaction meliorated significantly in GERD-HRQL of both subtypes of GERD, from 14.0±8.6 to 4.1±5.5 in EE group, from 18.7±8.3 to 8.4±7.2 in NERD group. (2). No significant difference was observed in all eight subscales of SF-36 between NERD and EE. However, the overall satisfaction of the GERD-HRQL of EE group is much better than that of NERD group. (3). The GERD patients were divided into two groups as CT (continuous treatment) and OT(on-demand treatment) during the period of 52-week PPI treatment. No significant difference in QoL was observed between CT and OT in both NERD and EE patients at follow. Conclusion Long-term, low-dose PPI treatment for GERD is effective for improvement of reflux symptoms and quality of life. Moreover, the curative results can maintain for a long term.
M1920 Differences in Predictive Factors for Efficacy of Proton Pump Inhibitor (PPI) Therapy for Reflux Esophagitis (RE) and Non-Erosive Reflux Disease (NERD) Masaki Miyamoto, Keisuke Takeuchi, Ken Haruma Background: Predictive factors for the efficacy of proton pump inhibitor (PPI) therapy for gastroesophageal reflux disease (GERD) have been reported, and, in general, the efficacy of PPI is considered lower for non-erosive reflux disease (NERD) than for reflux esophagitis (RE). Pathologically, some differences in the relationships among acid secretion, dysmotility, and enhanced hypersensitivity have been reported between NERD and RE, and predictive factors for PPI efficacy may also differ. Investigation of the predictive factors is especially important for Japanese people, whose acid secretion level is estimated to be lower than that of Western populations. Subjects and methods: 110 RE patients (age: 51.5±16.4 years, male/female: 61/49) and 243 NERD patients (age: 46.7±16.0 years, male/female: 84/159) visiting the hospital during the same period underwent 2-week PPI therapy. They answered the 12-item, Japanese, GERD-specific questionnaire, the Frequency Scale for the Symptoms of GERD (FSSG), before and after the therapy, and the improvement rates were evaluated. Patients who improved ≥50% were defined as “responders”, and patients' backgrounds and the FSSG results were examined to determine factors predictive of response. Results: 1. Responder rates were 59.1% (65/110) in RE and 50.2% (122/243) in NERD; the difference between the groups was not significant. 2. Comparisons of backgrounds and questionnaire responses between responders and non responders are shown in the table. 3. Factors associated with response After multivariate analysis including age, smoking, constipation, and two FSSG items (“Heavy stomach after meals ever?” and “Feel full while eating meals?”), age (odds 1.036, P=0.0190) in RE, and age (odds 1.022, P=0.0164) and constipation (odds 0.491, P=0.0155) in NERD were significant factors. Conclusions: Age (elderly) was a significant factor associated with response to PPI therapy in both RE and NERD. However, differences between RE and NERD were observed in the factors associated with response; stronger scores for two FSSG items (“Heavy stomach after meals ever?” and “Feel full while eating meals?”) were associated with non response, indicating that PPI therapy may have less efficacy in NERD patients with functional dyspepsia, such as postprandial distress syndrome.
M1918 Correlation Between Symptomatic Improvement and Quality of Life (QOL) On Gastroesophageal Reflux Disease (GERD) Tomohiro Kato, Kyoko Ito, Masayuki Saruta, Seiji Arihiro, Toshiki Nikami, Go Kobayashi, Kouji Hirohama, Hisao Tajiri Background: The goal of PPI therapy for gastroesophageal reflux disease (GERD) is a rapid disappearance of subjective symptoms and improvement of Quality of Life (QOL). A correlation between early symptomatic improvement of reflux esophagitis (RE) and nonerosive reflux disease (NERD) and QOL has been reported in Western patients. However, Japanese basal acid secretory capacity is lower compared with Westerners. Thus, whether symptomatic improvement influences QOL in Japanese is not yet defined. Methods: 36 GERD patients with epigastric symptoms (age: 56.6±12.6 years, male/female: 22/14, RE/ NERD: 10/22 (4 patients unconfirmed)) were given Rabeprazole 10mg/day for 8 weeks. Using the Japanese GERD questionnaire Frequency Scale for the Symptom of GERD, symptoms were assessed in 3 categories: total score of 12 questions (F-TS), score related to reflux disease (F-RS), and score related to dysmotility symptoms (F-DS). QOL was evaluated in 2 categories: physical component summary score (PCS) and mental component summary score (MCS) using SF-8 Health Survey pretreatment and after 4 and 8 weeks. Results: 1. Significant improvement of subjective symptom was shown in F-TS (14.9±1.1 to 6.2±1.1, P<0.0001), F-RS (8.0±0.7 to 3.2±0.7, P<0.0001) and F-DS (6.9±0.5 to 3.1±0.5, P<0.0001). Significant improvement of QOL was shown in PCS (47.3±0.9 to 49.8±0.9, P=0.0028) and MSC (47.9±1.1 to 51.1±0.8, P=0.0284) after the treatment. 2. Pretreatment F-TS showed negative correlation with QOL(PCS: r=-0.462, P=0.0003, MCS: r=-0.293, P=0.0284). F-RS showed significant negative correlation with PCS and MCS improvement rate as well. However, FDS only correlated with PCS (PCS: r=-0.399,P=0.0023). Although symptom and QOL improvement rates did not show significant correlation, MCS improvement rate and pretreatment F-DS showed significant positive correlation (r=0.328,P=0.0297). Conclusions: The worse subjective symptoms are, the lower QOL is. In addition, the stronger dysmotility symptom are, the greater the improvement of QOL with PPI therapy. However, correlation between symptom improvement and QOL improvement rate was not shown. It is concluded that PPI treatment efficacy was associated with pretreatment subjective symptom intensity.
M1921 Pantoprazole 20mg Versus 40mg Once Daily for Two Weeks for Heartburn or Reflux Symptoms Relief: A Meta-Analysis Yuhong Yuan, Neil D. Dattani, Changcheng Wang, Richard H. Hunt Background: Patients with heartburn or other reflux symptoms may take proton pump inhibitors for short-term use to relieve symptoms by over the counter (OTC) or prescription use before further investigation. Pantoprazole is one choice of PPI. We performed a metaanalysis to investigate whether pantoprazole 20mg provides similar short-term efficacy to 40mg in patients with heartburn or other reflux symptoms. Method: A comprehensive