High-dose esomeprazole for treatment of symptomatic refractory gastroesophageal reflux disease -A prospective pH-metry/impedance-controlled study

Monther Bajbouj, Valentin Becker, Veit Phillip, Dirk Wilhelm, Roland M. Schmid, Alexander Meining

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Background/Aims: Combined pH-metry/multichannel intraluminal impedance (pH/MII) measurement enables to measure gastroesophageal reflux despite ongoing proton pump inhibitor therapy. The aim of our study was to evaluate the influence of an escalating medical anti-reflux therapy with 40 mg esomeprazole, 80 mg esomeprazole and 80 mg esomeprazole plus baclofen for the treatment of refractory pathological reflux as determined by pH/MII. Methods: Symptomatic patients under 40 mg esomeprazole were screened by pH/MII. Patients with normal values in pH/MII were excluded; all others received 2 × 40 mg esomeprazole for another 4 weeks. Thereafter, the treatment effect was controlled by pH/MII. In the case of persistent pathological reflux, therapy was further escalated by adding baclofen and controlled after 3 months by pH/MII. Results: 45/138 (32.6%) patients showed pathological pH/MII despite ongoing therapy with 40 mg esomeprazole. In these, a significant reduction in liquid/mixed reflux events was observed after administering 2 × 40 mg (mean: 118.3 vs. mean: 66.6; p < 0.001), and pH/MII turned to normal in 32/45 (71.1%). Baclofen was additionally administered to 7/13 patients, which did not lead to a remarkable reduction in reflux events. Conclusion: In patients with abnormal pH/MII and persistent symptoms under 40 mg esomeprazole, we observed a significant reduction in liquid/mixed reflux events after increasing proton pump inhibitor dose up to 80 mg esomeprazole. Further escalation of therapy with baclofen has shown inconclusive results.

Original languageEnglish
Pages (from-to)112-118
Number of pages7
JournalDigestion
Volume80
Issue number2
DOIs
StatePublished - Oct 2009
Externally publishedYes

Keywords

  • Baclofen
  • Esomeprazole
  • Gastroesophageal reflux disease
  • Impedance monitoring
  • Proton pump inhibitors
  • Reflux

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