Management of symptoms in step-down therapy of gastroesophageal reflux disease
Article first published online: 19 JUL 2005
Journal of Gastroenterology and Hepatology
Volume 20, Issue 9, pages 1365–1370, September 2005
How to Cite
MINE, S., IIDA, T., TABATA, T., KISHIKAWA, H. and TANAKA, Y. (2005), Management of symptoms in step-down therapy of gastroesophageal reflux disease. Journal of Gastroenterology and Hepatology, 20: 1365–1370. doi: 10.1111/j.1440-1746.2005.03980.x
- Issue published online: 10 AUG 2005
- Article first published online: 19 JUL 2005
- Accepted for publication 14 October 2004.
- gastroesophageal reflux disease;
- H2-receptor antagonist;
- quality of life
Objective: Majority of studies on gastroesophageal reflux disease (GERD) that include patients with or without erosive disease have documented the efficacy of proton pump inhibitors (PPIs) as well as their superiority to H2-receptor antagonist (H2-RA). The purpose of this study was to clarify the difference in quality of GERD treatment with PPIs and H2-RA in step-down protocol using lansoprazole.
Methods: Forty-three patients with reflux esophagitis were randomly divided into three groups and assessed by severity score; group 1 received 30 mg lansoprazole initially and maintenance therapy with a standard dose H2-RA; group 2 received 30 mg of lansoprazole initially and maintenance therapy of 15 mg lansoprazole; and group 3 received 15 mg of lansoprazole once daily for 16 weeks. If the patients experienced symptomatic recurrence while on H2-RA, they were switched to PPI maintenance.
Results: Heartburn, regurgitation and dysphagia were hardly found in any group at 8 weeks after 15 mg or 30 mg lansoprazole treatment. After 8 weeks, however, heartburn and regurgitation recurred at 50% and 78.6%, respectively, in the stepped down to famotidine group, and quality of life (QOL) was significantly impaired. Endoscopic ultrasonography (EUS) analysis showed reduction of the submucosal layer without any change in the mucosal surface in the stepped down to famotidine group.
Conclusions: Step-down lansoprazole therapy is considered very effective in terms of rapid effect, long-term effect and high quality GERD treatment.
© 2005 Blackwell Publishing Asia Pty Ltd