Treatment Option for Patients with Non-Erosive Gastroesophageal Reflux Disease Refractory to a Standard Proton Pump Inhibitor

Abstract

Background: Non-erosive gastroesophageal reflux disease (NERD) resists treatment with standard proton pump inhibitor (PPI) doses in about 50% of patients. However, physicians do not have clear choices available for selecting alternative treatments for the refractory patients. Therefore, we investigated the effectiveness of double-dose PPI or a 5-hydroxytryptamine receptor antagonist (5HTRA) given with the standard PPI dose. Methods: We treated 10 NERD patients resistant to 10mg rabeprazole (RPZ) [RPZ(10)] with 20mg od RPZ [RPZ(20)] or 10mg od RPZ plus 5mg tid mosapride (RPZ-MOS) for 14-days in a cross-over manner. All patients' pHs were monitored for 24h and they were given a ＂Frequency Scale for the Symptoms of GERD＂ (FSSG) questionnaire to document their NERD symptoms, both on day 14. Results: The median FSSG score was significantly lowered by RPZ-MOS [7.0 (4-16), p＜0.01] and RPZ (20) [10.5 (1-28), p＜0.01] regimens compared with that for RPZ (10) [13.5 (10-31)]. However, FSSG scores were not significantly different between both regimens. The FSSG score was significantly associated with intragastric pH (p=0.02). The RPZMOS regimen's FSSG score was significantly correlated with RPZ (20) treatment (p=0.02). The FSSG scores of RPZ (10) in patients responsive to both regimens improved ≧30% compared with control scores. Conclusions: NERD patients whose FSSG score failed to decrease ≧30% after RPZ 10mg od treatment would be refractory to additional PPI or 5HTRA doses. FSSG scores after RPZ 10mg od treatment may provide a guideline for optimally treating NERD patients with a PPI.