Proton pump inhibitor step-down therapy for GERD:A multi-center study in Japan  

作　　者：Takao Tsuzuki Hiroyuki Okada Yoshiro Kawahara Ryuta Takenaka Junichiro Nasu Hidehiko Ishioka Akiko Fujiwara Fumiya Yoshinaga Kazuhide Yamamoto 

机构地区：[1]Department of Gastroenterology and Hepatology,Okayama University Graduate School of Medicine,Dentistry,and Pharmaceutical Sciences,Okayama 700-8558,Japan [2]Department of Internal Medicine,Tsuyama Central Hospital,Okayama 708-0841,Japan [3]Ishioka clinic,Hiroshima 721-0926,Japan [4]Department of Internal Medicine,Okayama Saiseikai General Hospital,Okayama 700-8511,Japan [5]Deparment of Internal Medicine,Mihara Red Cross Hospital,Hiroshima 723-8512,Japan

出　　处：《World Journal of Gastroenterology》2011年第11期1480-1487,共8页世界胃肠病学杂志（英文版）

摘　　要：AIM:To investigate the predictors of success in stepdown 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 in-vestigated 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 stepdown.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 stepdown require particular monitoring for relapse.AIM：To investigate the predictors of success in stepdown 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 in-vestigated 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 stepdown.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 stepdown require particular monitoring for relapse.

关 键 词：Gastroesophageal reflux disease Proton pump inhibitor OMEPRAZOLE Step-down therapy Gastrointestinal symptom rating scale 

分 类 号：R571[医药卫生—消化系统]