Brief Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Mar 21, 2011; 17(11): 1480-1487
Published online Mar 21, 2011. doi: 10.3748/wjg.v17.i11.1480
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
Takao Tsuzuki, Hiroyuki Okada, Yoshiro Kawahara, Junichiro Nasu, Kazuhide Yamamoto, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
Ryuta Takenaka, Department of Internal Medicine, Tsuyama Central Hospital, Okayama 708-0841, Japan
Hidehiko Ishioka, Ishioka clinic, Hiroshima 721-0926, Japan
Akiko Fujiwara, Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama 700-8511, Japan
Fumiya Yoshinaga, Deparment of Internal Medicine, Mihara Red Cross Hospital, Hiroshima 723-8512, Japan
Author contributions: Tsuzuki T contributed to statistical analysis and drafting the manuscript; Okada H contributed to planning, data collection, and drafting manuscript; Kawahara Y, Takenaka R, Naus J, Ishioka H, Fujiwara A and Yoshinaga F contributed to data collection; Yamamoto K and Okada H contributed to manuscript direction.
Correspondence to: Dr. Takao Tsuzuki, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
Telephone: +81-86-2357219 Fax: +81-86-2255991
Received: September 25, 2010
Revised: December 11, 2010
Accepted: December 18, 2010
Published online: March 21, 2011

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 step-down. 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 step-down require particular monitoring for relapse.

Keywords: Gastroesophageal reflux disease, Proton pump inhibitor, Omeprazole, Step-down therapy, Gastrointestinal symptom rating scale