Brief Article
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World J Gastroenterol. Apr 14, 2011; 17(14): 1858-1865
Published online Apr 14, 2011. doi: 10.3748/wjg.v17.i14.1858
Characteristics of non-erosive gastroesophageal reflux disease refractory to proton pump inhibitor therapy
Mitsushige Sugimoto, Masafumi Nishino, Chise Kodaira, Mihoko Yamade, Takahiro Uotani, Mutsuhiro Ikuma, Kazuo Umemura, Takahisa Furuta
Mitsushige Sugimoto, Takahisa Furuta, Center for Clinical Research, Hamamatsu University School of Medicine, Shizuoka Hamamatsu 431-3192, Japan
Masafumi Nishino, Chise Kodaira, Mihoko Yamade, Takahiro Uotani, Mutsuhiro Ikuma, First Department of Medicine, Hamamatsu University School of Medicine, ShizuokaHamamatsu 431-3192, Japan
Kazuo Umemura, Department of Pharmacology, Hamamatsu University School of Medicine, Shizuoka Hamamatsu 431-3192, Japan
Author contributions: Sugimoto M, Nishino M and Furuta T designed and performed the research; Sugimoto M, Nishino M, Mihoko Yamade, Kodaira C, Uotani T, Ikuma M, Umemura K and Furuta T wrote the paper.
Supported by a Grant-in-Aid from the Japanese Ministry of Education, Culture, Sports, Science and Technology (22790640)
Correspondence to: Mitsushige Sugimoto, MD, PhD, Center for Clinical Research, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan. mitsu@hama-med.ac.jp
Telephone: +81-53-4352261 Fax:+81-53-43409447
Received: November 16, 2010
Revised: December 22, 2010
Accepted: December 29, 2010
Published online: April 14, 2011
Abstract

AIM: To investigate whether potent acid inhibition is effective in non-erosive reflux disease (NERD) refractory to standard rabeprazole (RPZ) treatment.

METHODS: We treated 10 Japanese patients with NERD resistant to standard dosages of RPZ: 10 mg or 20 mg od, 20 mg bid, or 10 mg qid for 14 d. All patients completed a frequency scale for symptoms of gastroesophageal reflux disease questionnaire frequency scale for the symptoms of GERD (FSSG); and underwent 24 h pH monitoring on day 14.

RESULTS: With increased dosages and frequency of administration of RPZ, median intragastric pH significantly increased, and FSSG scores significantly decreased. With RPZ 10 mg qid, potent acid inhibition was attained throughout 24 h. However, five subjects were refractory to RPZ 10 mg qid, although the median intragastric pH in these subjects (6.6, range: 6.2-7.1) was similar to that in the remaining five responsive subjects (6.5, range: 5.3-7.3). With baseline RPZ 10 mg od, FSSG scores in responsive patients improved by > 30%, whereas there was no significant decrease in the resistant group.

CONCLUSION: NERD patients whose FSSG score fails to decrease by > 30% after treatment with RPZ 10 mg od for 14 d are refractory to higher dosage.

Keywords: Non-erosive reflux disease; Rabeprazole; CYP2C19