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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Factors associated with residual gastroesophageal reflux disease symptoms in patients receiving proton pump inhibitor maintenance therapy
Fumiaki Kawara, Tsuyoshi Fujita, Yoshinori Morita, Atsushi Uda, Atsuhiro Masuda, Masaya Saito, Makoto Ooi, Tsukasa Ishida, Yasuyuki Kondo, Shiei Yoshida, Tatsuya Okuno, Yoshihiko Yano, Masaru Yoshida, Hiromu Kutsumi, Takanobu Hayakumo, Kazuhiko Yamashita, Takeshi Hirano, Midori Hirai, Takeshi Azuma
Fumiaki Kawara, Tsuyoshi Fujita, Yoshinori Morita, Atsuhiro Masuda, Masaya Saito, Makoto Ooi, Tsukasa Ishida, Yasuyuki Kondo, Shiei Yoshida, Tatsuya Okuno, Yoshihiko Yano, Masaru Yoshida, Hiromu Kutsumi, Takanobu Hayakumo, Takeshi Azuma, Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
Atsushi Uda, Kazuhiko Yamashita, Takeshi Hirano, Midori Hirai, Department of Pharmacy, Kobe University Hospital, Kobe, Hyogo 650-0017, Japan
Author contributions: Fujita T and Azuma T designed the study; Kawara F and Fujita T analyzed the data and wrote the manuscript; Morita Y, Uda A, Saito M, Ooi M, Ishida T, Kondo Y, Yoshida S, Okuno T and Yano Y collected the data and revised the manuscript; Masuda A, Yoshida M, Kutsumi H, Hayakumo T, Yamashita K, Hirano T and Hirai M interpreted the data; and Azuma T supervised the study and revised the manuscript.
Institutional review board statement: This study was approved by the ethics committee of Kobe University Hospital.
Informed consent statement: Informed consent was obtained from all subjects before enrollment.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tsuyoshi Fujita, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan. tsufuji@med.kobe-u.ac.jp
Telephone: +81-78-3826305 Fax: +81-78-3826309
Received: December 11, 2016
Peer-review started: December 12, 2016
First decision: December 29, 2016
Revised: January 24, 2017
Accepted: February 17, 2017
Article in press: February 17, 2017
Published online: March 21, 2017
AIM
To elucidate the factors associated with residual gastroesophageal reflux disease (GERD) symptoms in patients receiving proton pump inhibitor (PPI) maintenance therapy in clinical practice.
METHODS
The study included 39 GERD patients receiving maintenance PPI therapy. Residual symptoms were assessed using the Frequency Scale for Symptoms of GERD (FSSG) questionnaire and the Gastrointestinal Symptom Rating Scale (GSRS). The relationships between the FSSG score and patient background factors, including the CYP2C19 genotype, were analyzed.
RESULTS
The FSSG scores ranged from 1 to 28 points (median score: 7.5 points), and 19 patients (48.7%) had a score of 8 points or more. The patients’ GSRS scores were significantly correlated with their FSSG scores (correlation coefficient = 0.47, P < 0.005). In erosive esophagitis patients, the FSSG scores of the CYP2C19 rapid metabolizers (RMs) were significantly higher than the scores of the poor metabolizers and intermediate metabolizers (total scores: 16.7 ± 8.6 vs 7.8 ± 5.4, P < 0.05; acid reflux-related symptom scores: 12 ± 1.9 vs 2.5 ± 0.8, P < 0.005). In contrast, the FSSG scores of the CYP2C19 RMs in the non-erosive reflux disease patients were significantly lower than those of the other patients (total scores: 5.5 ± 1.0 vs 11.8 ± 6.3, P < 0.05; dysmotility symptom-related scores: 1.0 ± 0.4 vs 6.0 ± 0.8, P < 0.01).
CONCLUSION
Approximately half of the GERD patients receiving maintenance PPI therapy had residual symptoms associated with a lower quality of life, and the CYP2C19 genotype appeared to be associated with these residual symptoms.
Core tip: The relationships between residual gastroesophageal reflux disease (GERD) symptoms in patients receiving proton pump inhibitor (PPI) maintenance therapy and patient background factors, including the CYP2C19 genotype, were evaluated. Approximately half of the GERD patients receiving maintenance PPI therapy had residual symptoms associated with a lower quality of life. Although the CYP2C19 genotype appeared to be associated with these residual symptoms, the impact in the erosive esophagitis patients was distinct from the impact in the non-erosive reflux disease patients.
