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Huh CW, Youn YH, Jung DH, Cha RR, Kim YJ, Jung K, Song KH, Bang KB, Tae CH, Choi SI, Shin CM. Efficacy of Tegoprazan in Patients With Functional Dyspepsia: A Prospective, Multicenter, Single-arm Study. J Neurogastroenterol Motil 2024; 30:313-321. [PMID: 38710534 PMCID: PMC11238105 DOI: 10.5056/jnm23150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/21/2023] [Accepted: 12/17/2023] [Indexed: 05/08/2024] Open
Abstract
Background/Aims Acid-suppressive drugs, such as proton pump inhibitors (PPIs), are treatment options for functional dyspepsia (FD). However, the efficacy of potassium-competitive acid blockers (P-CABs) in treating FD has not yet been established. This prospective multicenter clinical trial-based study aimed to assess the efficacy and safety of tegoprazan as a P-CAB treatment in patients with FD. Methods FD was diagnosed using the Rome IV criteria. All patients received tegoprazan 50 mg once daily for 8 weeks. Dyspeptic symptoms were assessed using a dyspepsia symptom questionnaire (5-point Likert scale, Nepean Dyspepsia Index-Korean [NDI-K], and gastroesophageal reflux disease-health-related quality of life [GERD-HRQL]). The main outcome was satisfactory symptom relief rates at 8 weeks. Results In this study, from the initial screening of 209 patients, 173 were included in the per-protocol set analysis. Satisfactory symptom relief rates at 8 and 4 weeks were 86.7% and 74.6%, respectively. In addition, the NDI-K and GERD-HRQL scores significantly improved at 8 and 4 weeks compared with the baseline scores. The efficacy of tegoprazan was not influenced by the FD subtype or Helicobacter pylori status. In patients with overlapping FD and GERD, there was a greater improvement in the NDI-K and GERD-HRQL scores than in patients with FD symptoms only. No serious drug-related adverse events occurred during this study. Conclusion Tegoprazan (50 mg) administered once daily provided satisfactory symptom relief for FD.
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Affiliation(s)
- Cheal Wung Huh
- Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Hoon Youn
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Da Hyun Jung
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ra Ri Cha
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju, Gyeongsangnam-do, Korea
| | - Yeon Ji Kim
- Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoungwon Jung
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Kyung Ho Song
- Department of Internal Medicine, CHA Ilsan Medical Center, CHA University, School of Medicine, Goyang, Gyeonggi-do, Korea
| | - Ki Bae Bang
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Chungcheongnam-do, Korea
| | - Chung Hyun Tae
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Soo In Choi
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Cheol Min Shin
- Department of Gastroenterology, Seoul National University Bundang Hospital, Bundang, Gyeonggi-do, Korea
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Crispino P, Ciarambino T, Giordano M. Variation in Fatty Acid Synthase, Ki67 and p53 Esophageal Mucosa Expressions in Barrett's Esophagus Patients Treated for One Year with Two Esomeprazole Different Regimens. Curr Issues Mol Biol 2023; 45:4701-4715. [PMID: 37367048 DOI: 10.3390/cimb45060299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Barrett's esophagus (BE) is an acquired pre-malignant condition that results from chronic gastroesophageal reflux. The malignant transformation occurred in 0.5% of patients/year and was independent of medical and endoscopic conservative treatments. Fatty acid synthase (FAS) is a multifunctional enzyme that catalyzes the synthesis of long-chain fatty acids from acetyl-coenzyme A, malonyl-coenzyme A, a reduced form of nicotinamide adenine dinucleotide phosphate (NADPH), and adenosine triphosphate. Activation of FAS is closely linked to malignant transformation. The aim of the present study was to evaluate the variation of FAS, p53, and Ki67 expressions in two groups of 21 BE patients each, after one year of continuous (group A) or discontinuous (group B) treatment with esomeprazole 40 mg/day in comparison to the initial expression. In both the two groups of BE patients, biopsies were taken from pathologic sites of the mucosa for histological and immuno-histochemical detection of FAS, Ki67, and p53 at entry and after one year of Esomeprazole 40 mg treatment. FAS expression was positive when a strong granular cytoplasmic staining was observed in esophageal cells. Ki67 and p53 were defined as positive when nuclear staining was clearly detected at ×10 magnification. FAS expression was reduced in 43% of patients treated with Esomeprazole continuously in comparison to the 10% of patients treated with Esomeprazole on demand (p = 0.002). Ki67 expression was reduced in 28% of continuously treated patients in comparison to 5% of patients treated on demand (p = 0.001). The p53 expression decreased in 19% of continuously treated patients in comparison to an increase in 2 patients (9%) treated on demand (p = 0.05). Continuously Esomeprazole treatment could help in the diminution of metabolic and proliferative activities in the esophageal columnar epithelium and in part it can help prevent the oxidative damage against cellular DNA, resulting in a diminution in p53 expression.
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Affiliation(s)
- Pietro Crispino
- UOC of Internal Medicine, Santa Maria Goretti Hospital, 04100 Latina, Italy
| | - Tiziana Ciarambino
- UOC of Internal Medicine, Hospital of Marcianise, "Caserta Local Health Authority", 81025 Marcianise, Italy
| | - Mauro Giordano
- Advanced Medical and Surgical Sciences Department, University of Campania, L. Vanvitelli, 81100 Naples, Italy
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Nakada T, Isshi K, Matsuhashi N, Iwakiri K, Kamiya T, Manabe N, Higuchi K, Joh T, Oshio A, Ogawa M, Hokari A, Saruta M, Haruma K, Nakada K. Comparison of the effects of individual symptoms of gastroesophageal reflux disease co-existing functional dyspepsia on patients' daily lives: A prospective, observational study. JGH Open 2022; 6:886-893. [PMID: 36514504 PMCID: PMC9730724 DOI: 10.1002/jgh3.12837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/10/2022] [Accepted: 10/15/2022] [Indexed: 11/07/2022]
Abstract
Background and Aim Patients with gastroesophageal reflux disease (GERD) frequently also have functional dyspepsia (FD) symptoms, which impair their quality of life. However, the magnitude and characteristics of the effects of each symptom on daily life have been unclarified. Using multiple regression analysis, we aimed to clarify these questions. Methods We enrolled 290 patients from 29 institutions across Japan, in this prospective, observational study. Patients responded to three questionnaires (Gastroesophageal Reflux and Dyspepsia Therapeutic Efficacy and Satisfaction Test [GERD-TEST], Hospital Anxiety and Depression Scale [HADS], and 8-item Short-Form Health Survey [SF-8]) before and after 4 weeks of proton pump inhibitor treatment. Pearson correlation and multiple regression analyses were conducted between symptoms such as typical GERD, epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS) of FD, and aspects of daily life, namely, level of satisfaction with the daily life of GERD-TEST, anxiety and depression score of HADS, and physical and mental component summary of SF-8. Results Pearson correlation analysis showed a significant correlation in all combinations between GERD/FD-EPS/FD-PDS symptoms and the nine aspects of daily life. However, multiple regression analysis results deviated from these results, with the most significant effects seen in the PDS-symptom subscale (SS) on the five aspects of daily life, that is, dissatisfaction with eating, daily life-SS, anxiety, depression, and mental component summary (MCS) whereas the significant effects in GERD-SS on five aspects of daily life, that is, dissatisfaction for eating, anxiety, depression, physical component summary, and MCS, disappeared. Conclusion Dealing with co-existing FD symptoms without overlooking them may be important in the management of GERD.
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Affiliation(s)
- Tatsuya Nakada
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Katsushika Medical CenterThe Jikei University School of MedicineTokyoJapan
| | - Kimio Isshi
- Isshi Gastro‐Intestinal Clinic and Department of EndoscopyThe Jikei University School of MedicineTokyoJapan
| | | | - Katsuhiko Iwakiri
- Department of GastroenterologyNippon Medical School Graduate School of MedicineTokyoJapan
| | - Takeshi Kamiya
- Department of Medical InnovationNagoya City University Graduate School Medical SciencesNagoyaJapan
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Laboratory MedicineKawasaki Medical SchoolOkayamaJapan
| | - Kazuhide Higuchi
- Second Department of Internal MedicineOsaka Medical and Pharmaceutical UniversityOsakaJapan
| | | | - Atsushi Oshio
- Faculty of Letters, Arts and SciencesWaseda UniversityTokyoJapan
| | - Maiko Ogawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Katsushika Medical CenterThe Jikei University School of MedicineTokyoJapan
| | - Atsushi Hokari
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Katsushika Medical CenterThe Jikei University School of MedicineTokyoJapan
| | - Masayuki Saruta
- Division of Gastroenterology and Hepatology, Department of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Ken Haruma
- Department of General Internal Medicine 2Kawasaki Medical School Kawasaki HospitalOkayamaJapan
| | - Koji Nakada
- Department of Laboratory MedicineThe Jikei University School of MedicineTokyoJapan
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Clinical significance of gastroesophageal reflux disease with minimal change: a multicenter prospective observational study. Sci Rep 2022; 12:15036. [PMID: 36057730 PMCID: PMC9440892 DOI: 10.1038/s41598-022-19408-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 08/29/2022] [Indexed: 11/08/2022] Open
Abstract
Non-erosive reflux disease (NERD) is classified into grade N (no minimal change) and grade M (minimal change) based on the Los Angeles classification. However, few reports have described the clinical characteristics of grade M. This study was performed to clarify the clinical characteristics of grade M. Among 290 consecutive patients with gastroesophageal reflux disease (GERD), 45 patients with grade M, 62 patients with grade N, and 94 patients with grade A were compared with respect to clinical differences. The degree of symptom improvement after 4 weeks of proton pump inhibitor administration was also prospectively compared among the three groups. Grades N and M showed no or little difference in the patients’ backgrounds (including sex and body mass index), GERD/functional dyspepsia symptom scores, life dissatisfaction (diet, sleep, work, and mood), Short Form-8 (mental component summary) scores, and symptom improvement. In contrast, significant differences were present between grades M and A as well as between grades N and A. The overall results of our study suggest that the distinction between grade M and grade N is of little clinical significance from the viewpoint of clinical characteristics.
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Isshi K, Furuhashi H, Koizumi A, Nakada K. Effects of coexisting upper gastrointestinal symptoms on daily life and quality of life in patients with gastroesophageal reflux disease symptoms. Esophagus 2021; 18:684-692. [PMID: 33389239 DOI: 10.1007/s10388-020-00801-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/12/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIM Gastroesophageal reflux disease (GERD) is a common disease encountered in daily medical care and clinical problem which hampers daily life and reduces quality of life (QOL). The coexistence of GERD-related symptoms with the typical GERD symptoms, such as heartburn or acid regurgitation, and various upper abdominal symptoms is frequently observed in patients with GERD. However, the effect of these coexisting symptoms on the daily life and QOL of patients with GERD has not been clarified. Therefore, the effects of the various upper abdominal symptoms coexisting with GERD on the daily life and QOL of such patients were compared. METHODS A total of 113 newly diagnosed patients who visited our hospital with typical GERD symptoms were assessed using the modified frequency scale for the symptoms of GERD (MFSSG), gastroesophageal reflux and dyspepsia therapeutic efficacy and satisfaction test (GERD-TEST), and short-form 8-item health survey (SF-8) questionnaires. The "gastroesophageal reflux symptom" (7 items) and "dyspepsia symptom" (7 items) groups were divided into two "typical symptoms" and two "atypical symptoms" for a total of four categories. The Pearson's correlation coefficient and multiple regression analysis were used to evaluate the correlations between each symptom category and dissatisfaction for daily life [eating, sleeping, daily activities, mood, as well as dissatisfaction for daily life-symptom subscale (SS), which is the average of the four items in the GERD-TEST, the physical component summary [PCS] and mental component summary [MCS] of the SF-8, and the influence of each symptom category on the daily life and QOL. RESULTS The incidences of each symptom category in patients with GERD were high: typical GERD (100%), atypical GERD symptoms (67.3%), typical functional dyspepsia (FD) (71.7%), and atypical FD (75.2%). Pearson's correlation analysis demonstrated significant correlations between each symptom category and living status (dissatisfactions of eating, sleeping, daily activities, daily life-SS) and almost all items in SF-8 (PCS, MCS) (P < 0.05). Multiple regression analysis indicated the largest influences of each symptom category on living status and QOL in descending order: dissatisfaction for eating (atypical FD, typical FD), daily activities (atypical FD, typical FD, typical GERD), mood (atypical FD), daily life-SS (atypical FD, typical FD), PCS (typical FD), and MCS (atypical FD) (P < 0.05). CONCLUSION Coexisting FD symptoms, particularly atypical FD symptoms, had a large influence on the impairments of daily life and decreases in QOL. Daily medical care of GERD requires attention to coexisting symptoms and their treatment instead of just focusing on the chief complaints by patients.
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Affiliation(s)
- Kimio Isshi
- Isshi Gastro-Intestinal Clinic, 2-15-21, Shinozaki-cho, Edogawa-ku, Tokyo, 133-0061, Japan. .,Department of Endoscopy, The Jikei University School of Medicine, 3-15-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan.
| | - Hiroto Furuhashi
- Isshi Gastro-Intestinal Clinic, 2-15-21, Shinozaki-cho, Edogawa-ku, Tokyo, 133-0061, Japan.,Department of Endoscopy, The Jikei University School of Medicine, 3-15-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Akio Koizumi
- Isshi Gastro-Intestinal Clinic, 2-15-21, Shinozaki-cho, Edogawa-ku, Tokyo, 133-0061, Japan.,Department of Endoscopy, The Jikei University School of Medicine, 3-15-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Koji Nakada
- Isshi Gastro-Intestinal Clinic, 2-15-21, Shinozaki-cho, Edogawa-ku, Tokyo, 133-0061, Japan.,Department of Laboratory Medicine, The Jikei University School of Medicine, 3-15-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan
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Ogawa M, Arihiro S, Matsuhashi N, Joh T, Higuchi K, Iwakiri K, Kamiya T, Manabe N, Isshi K, Nakada T, Hokari A, Saruta M, Oshio A, Haruma K, Nakada K. The early therapeutic response at 2 weeks is a crucial predictor of proton pump inhibitor-refractory gastroesophageal reflux disease. Esophagus 2021; 18:398-406. [PMID: 33136239 DOI: 10.1007/s10388-020-00792-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/18/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND In recent years, the prevalence of proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease (GERD) has been increasing, posing a clinical obstacle to improving the management of GERD patients. The ability of known predictive factors to explain therapeutic response to PPI remains insufficient. Therefore, we examined whether the addition of early therapeutic response to PPI as an explanatory variable may increase the predictive power for PPI-refractory GERD. METHODS The severity and therapeutic response of GERD symptoms to PPI were evaluated using the GastroEsophageal Reflux and Dyspepsia Therapeutic Efficacy and Satisfaction Test (GERD-TEST) questionnaire at baseline and at 2 and 4 weeks after treatment. The relevance of the therapeutic effect of PPI at 2 weeks compared to that at 4 weeks was examined in 301 patients with GERD. Independent predictive factors for refractory GERD at 4 weeks of PPI therapy were examined in 182 patients. The effect of various clinical factors, including the early response to PPI, was assessed using multiple regression analysis. RESULTS The number of PPI-therapy responders increased significantly with the duration of treatment (p < 0.0001). The response to PPI therapy at 2 weeks was significantly correlated with that at 4 weeks (p < 0.0001). Multiple regression analysis revealed that the therapeutic response to PPI at 2 weeks was by far the strongest predictor of the therapeutic effect at 4 weeks among all clinical factors. CONCLUSIONS Medication change for PPI-refractory GERD at 2 weeks may be an efficacious therapeutic strategy to improve patients' quality of life.
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Affiliation(s)
- Maiko Ogawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Seiji Arihiro
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan
| | | | | | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Katsuhiko Iwakiri
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Takeshi Kamiya
- Department of Medical Innovation, Nagoya City University Graduate School Medical Sciences, Nagoya, Japan
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Kimio Isshi
- Isshi Gastro-Intestinal Clinic, Tokyo, Japan
| | - Tatsuya Nakada
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Atsushi Hokari
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Masayuki Saruta
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Atsushi Oshio
- Faculty of Letters, Arts and Sciences, Waseda University, Tokyo, Japan
| | - Ken Haruma
- Department of General Internal Medicine 2, Kawasaki Medical School Kawasaki Hospital, Okayama, Japan
| | - Koji Nakada
- Department of Laboratory Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
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Isshi K, Matsuhashi N, Joh T, Higuchi K, Iwakiri K, Kamiya T, Manabe N, Nakada T, Ogawa M, Arihiro S, Haruma K, Nakada K. Clinical features and therapeutic responses to proton pump inhibitor in patients with severe reflux esophagitis: A multicenter prospective observational study. JGH Open 2021; 5:99-106. [PMID: 33490619 PMCID: PMC7812480 DOI: 10.1002/jgh3.12455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM In patients with severe erosive reflux disease (ERD; Los Angeles classification grade C/D) who do not undergo endoscopic examination, insufficient strength and duration of proton pump inhibitor (PPI) therapy may lead to complications such as esophageal bleeding and stenosis. Therefore, to provide a safe and effective treatment for gastroesophageal reflux disease (GERD), we investigated the clinical features of patients with severe ERD and their responses to PPI therapy. METHODS Patients with GERD symptoms received PPI therapy for 4 weeks after endoscopic examination. The patients completed the Gastroesophageal reflux and dyspepsia therapeutic efficacy and satisfaction test questionnaire before and 2 or 4 weeks after PPI treatment. Patient characteristics, presence/absence of coexisting atrophic gastritis (AG) and hiatus hernia (HH), and responses to PPI therapy were compared in patients with GERD among three groups (nonerosive reflux disease, mild ERD [grade A/B], and severe ERD). RESULTS The severe ERD group had a significantly higher proportion of males, higher body mass index, and longer duration of GERD morbidity. Furthermore, the severe ERD group also had a significantly lower incidence of coexisting AG and higher incidence of HH. There was no difference in the severity of GERD before PPI treatment among the three groups. Unexpectedly, the response to PPI therapy was the best in the severe ERD group. CONCLUSION Sufficient strength and period of PPI therapy are required, even if the symptoms show early improvement, when treating GERD patients without performing endoscopy, considering the possibility of severe ERD.
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Affiliation(s)
- Kimio Isshi
- Department of GastroenterologyIsshi Gastro‐Intestinal Clinic2‐15‐21, Shinozaki‐choEdogawa‐Ku133‐0061TokyoJapan
- Department of EndoscopyThe Jikei University School of Medicine3‐15‐8, NishishinbashiMinato‐Ku105‐8461TokyoJapan
| | - Nobuyuki Matsuhashi
- Department of GastroenterologyNTT Medical Center Tokyo5‐9‐22, Higashi‐GotandaShinagawa‐Ku144‐8625TokyoJapan
| | - Takashi Joh
- Department of GastroenterologyGamagori City Hospital1‐1, Mukaida Hirata‐choGamagori443‐8501AichiJapan
| | - Kazuhide Higuchi
- Second Department of Internal MedicineOsaka Medical College2‐7, DaigakumachiTakatsuki569‐8686OsakaJapan
| | - Katsuhiko Iwakiri
- Department of GastroenterologyNippon Medical School Graduate School of Medicine1‐1‐5, SendagiBunkyo‐Ku133‐8603TokyoJapan
| | - Takeshi Kamiya
- Department of Medical InnovationNagoya City University Graduate School Medical Sciences1, Kwasumi Mizuhocho, Mizuho‐KuNagoya467‐8601AichiJapan
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Laboratory MedicineKawasaki Medical School2‐6‐1, Nakasange, Kita‐KuOkayama700‐8505OkayamaJapan
| | - Tatsuya Nakada
- Division of Gastroenterology and Hepatology, Department of Internal MedicineKatsushika Medical Center, The Jikei University School of Medicine6‐41‐2, AotoKatsushika‐Ku125‐8506TokyoJapan
| | - Maiko Ogawa
- Division of Gastroenterology and Hepatology, Department of Internal MedicineKatsushika Medical Center, The Jikei University School of Medicine6‐41‐2, AotoKatsushika‐Ku125‐8506TokyoJapan
| | - Seiji Arihiro
- Division of Gastroenterology and Hepatology, Department of Internal MedicineKatsushika Medical Center, The Jikei University School of Medicine6‐41‐2, AotoKatsushika‐Ku125‐8506TokyoJapan
| | - Ken Haruma
- Department of General Internal Medicine 2Kawasaki Medical School Kawasaki Hospital577, MatsushimaKurashiki701‐0192OkayamaJapan
| | - Koji Nakada
- Department of Laboratory MedicineThe Jikei University School of Medicine3‐25‐8, NishishinbashiMinato‐Ku105‐8461TokyoJapan
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Isshi K, Furuhashi H, Nakada K. Therapeutic strategy for the patients with coexisting gastroesophageal reflux disease and postprandial distress syndrome of functional dyspepsia. JGH Open 2020; 4:582-588. [PMID: 32782942 PMCID: PMC7411656 DOI: 10.1002/jgh3.12299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/20/2019] [Accepted: 12/30/2019] [Indexed: 12/22/2022]
Abstract
Background and Aim Gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) frequently overlap. However, no accepted treatment has yet been established for such patients. This study was conducted to identify an adequate initial treatment for patients with GERD accompanied by the postprandial distress syndrome type of FD (FD‐PDS). Methods Of the 150 patients newly diagnosed with GERD who visited our clinic, 53 patients with the typical symptoms of both GERD and FD‐PDS were assessed using the modified frequency scale for the symptoms of GERD and the gastroesophageal reflux and dyspepsia therapeutic efficacy and satisfaction test questionnaires. Of those, 42 patients who completed 4 weeks of treatment were analyzed. We compared the treatment responses between the 21 patients who received proton pump inhibitor (PPI) monotherapy and 21 patients who received a PPI in combination with the prokinetic drug acotiamide. Results Assessment of the two questionnaires revealed a marked improvement of both GERD and FD symptom scores after 4 weeks of treatment in both groups. However, there were no significant differences in any GERD or FD symptom scores at baseline, after 4 weeks of treatment and in the symptom score change between the two different treatment groups. Conclusion The results of this retrospective study suggest no benefit of PPI‐prokinetic combination versus PPI monotherapy in adult patients with FD‐GERD overlap; therefore, PPI monotherapy could be an adequate initial treatment for such patients.
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Affiliation(s)
- Kimio Isshi
- Department of Gastoroenterology, Isshi Gastro-Intestinal Clinic Tokyo Japan.,Department of Endoscopy Jikei University School of Medicine Tokyo Japan
| | - Hiroto Furuhashi
- Department of Gastoroenterology, Isshi Gastro-Intestinal Clinic Tokyo Japan.,Department of Endoscopy Jikei University School of Medicine Tokyo Japan
| | - Koji Nakada
- Department of Gastoroenterology, Isshi Gastro-Intestinal Clinic Tokyo Japan.,Department of Laboratory Medicine The Jikei University Daisan Hospital Tokyo Japan
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Yokoya Y, Igarashi A, Uda A, Deguchi H, Takeuchi T, Higuchi K. Cost-utility analysis of a 'vonoprazan-first' strategy versus 'esomeprazole- or rabeprazole-first' strategy in GERD. J Gastroenterol 2019; 54:1083-1095. [PMID: 31396703 DOI: 10.1007/s00535-019-01609-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/31/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) can be treated using a vonoprazan-first strategy (first-line treatment with vonoprazan), or esomeprazole-first/rabeprazole-first strategies (first-line treatment with proton-pump inhibitors [PPIs], esomeprazole/rabeprazole, followed by a switch to vonoprazan). This cost-utility analysis used long-term simulation modeling to evaluate the cost-effectiveness of a vonoprazan-first strategy compared with the esomeprazole-first and rabeprazole-first strategies. METHODS A Markov simulation model was developed to evaluate the cost-effectiveness of vonoprazan-first, esomeprazole-first, and rabeprazole-first strategies, comprising healing and maintenance therapies, over 5 years (4-week cycles). Healing therapy began with the administration of a normal dose of drug per real-world practice. If patients were not healed endoscopically, either a longer duration of healing therapy was provided (vonoprazan), the dose was increased (rabeprazole), or patients were switched to vonoprazan (immediately for esomeprazole, and after dose-escalation for rabeprazole, respectively). Healed patients received maintenance (lower/same dose as healing therapy). Recurrence resulted in re-challenge with healing therapy. Transition probabilities were derived from the results of indirect comparisons (network meta-analysis) and costs calculated from the Japanese payer perspective. Outcomes were defined as quality-adjusted life years (QALYs), with utilities based on published values. RESULTS Expected costs of the vonoprazan-, esomeprazole-, and rabeprazole-first strategies were ¥36,194, ¥76,719, and ¥41,105, respectively, over 5 years. QALY gains for vonoprazan-first strategy versus the esomeprazole- and rabeprazole-first strategies were 0.014 and 0.003, respectively. Both estimated incremental cost-effectiveness ratios were dominant and robust to two sensitivity analyses. CONCLUSIONS Vonoprazan-first strategy increased QALYs and appeared to be cost-effective for GERD patients compared with the esomeprazole- or rabeprazole-first strategies.
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Affiliation(s)
- Yuta Yokoya
- Second Department of Internal Medicine, Osaka Medical College, 2-7 Digaku-cho, Takatsuki, Japan
| | - Ataru Igarashi
- Unit of Public Health and Preventive Medicine, School of Medicine, Yokohama City University, Yokohama, Japan.,Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Akihito Uda
- Japan Medical Affairs, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Hisato Deguchi
- Japan Medical Affairs, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical College, 2-7 Digaku-cho, Takatsuki, Japan.
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College, 2-7 Digaku-cho, Takatsuki, Japan
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10
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Isshi K, Matsuhashi N, Joh T, Higuchi K, Iwakiri K, Kamiya T, Manabe N, Ogawa M, Arihiro S, Haruma K, Nakada K. Proton pump inhibitor monotherapy is effective to attenuate dyspepsia symptoms associated with gastroesophageal reflux disease: a multicenter prospective observational study. J Gastroenterol 2019; 54:492-500. [PMID: 30673836 DOI: 10.1007/s00535-019-01546-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/18/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) are frequently overlapped. However, no treatment strategies have been established yet for such patients. This study compared the effects of proton pump inhibitor (PPI) treatment in patients with GERD-associated FD among three groups with varying severity levels of GERD symptoms. METHODS The patients with GERD and FD symptoms received PPI treatment for 4 weeks after endoscopy, and the severity of the symptoms and responses to treatment were evaluated at before and after 4 weeks of treatment using the Gastroesophageal Reflux and Dyspepsia Therapeutic Efficacy and Satisfaction Test (GERD-TEST). The patients were divided into three groups in accordance with the severity of the GERD symptoms as assessed by the GERD symptom subscale (SS) scores of pre-treatment. RESULTS Data from 233 cases of 40 mild, 151 moderate and 42 severe symptoms were analyzed. Analysis of the pre-treatment scores for each symptom revealed that a higher GERD-SS score was significantly associated with higher scores on any kind of FD score. Four weeks of PPI treatment significantly and markedly alleviated any of GERD/FD symptoms. Most importantly, change in the score for each symptom after 4 weeks of treatment relative to the pre-treatment score was significantly greater in the groups with more severe GERD-SS. CONCLUSION FD symptoms associated with more severe GERD symptoms are supposed to be acid-related dyspepsia, and PPI monotherapy is recommended as the treatment of first choice in such patients.
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Affiliation(s)
- Kimio Isshi
- Isshi Gastro-Intestinal Clinic, 2-15-21, Shinozaki-Cho, Edogawa-ku, Tokyo, 133-0061, Japan. .,Department of Endoscopy, Jikei University School of Medicine, 3-15-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan.
| | - Nobuyuki Matsuhashi
- Department of Gastroenterology, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-Ku, Tokyo, 105-8461, Japan
| | - Takashi Joh
- Gamagori City Hospital, 1-1 Mukaida, Hirata-Cho, Gamagori-City, Aichi, 443-8501, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Katsuhiko Iwakiri
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 133-8603, Japan
| | - Takeshi Kamiya
- Department of Medical Innovation, Nagoya City University Graduate School Medical Sciences, 1, Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Laboratory Medicine, Kawasaki Medical School General Medical Center, 2-6-1, Nakayamashita, Kita-Ku, Okayama-City, Okayama, 700-8505, Japan
| | - Maiko Ogawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Katsushika Medical Center Jikei University School of Medicine, 6-41-2, Aoto, Katsushika-Ku, Tokyo, 125-8506, Japan
| | - Seiji Arihiro
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Katsushika Medical Center Jikei University School of Medicine, 6-41-2, Aoto, Katsushika-Ku, Tokyo, 125-8506, Japan
| | - Ken Haruma
- Department of General Internal Medicine 2, Kawasaki Medical School Kawasaki Hospital, 577, Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Koji Nakada
- Department of Laboratory Medicine, The Jikei University Daisan Hospital, 4-11-1, Izumihon-Cho, Komae-City, Tokyo, 201-8601, Japan
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11
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Jung HK, Choi MG, Baek MK, Wu JCY. Development and Psychometric Assessment of a Self-evaluation Questionnaire for Gastroesophageal Reflux Disease. J Neurogastroenterol Motil 2018; 24:584-592. [PMID: 30347937 PMCID: PMC6175548 DOI: 10.5056/jnm18085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/11/2018] [Accepted: 07/31/2018] [Indexed: 12/13/2022] Open
Abstract
Background/Aims There is uncertainty about how to measure outcomes reported by patients in gastroesophageal reflux disease (GERD). This study was conducted to develop an instrument and to determine of the definition of respondent for a patient reported outcomes to assess the efficacy of a treatment used for GERD treatment. Methods A structural process has developed a self-evaluation questionnaire for GERD (SEQ-GERD); health-related quality of life questionnaire for GERD (GERD-QOL) was translated through cross-cultural validation. Two-week reproducibility was evaluated and construct validity was assessed by correlating the SEQ-GERD with the Patient Assessment of Gastrointestinal Disorders (PAGI-SYM), the reflux disease questionnaire (RDQ), and GERD-QOL. Changes in SEQ-GERD scores were compared to assess the discriminative validity following 4 weeks of proton pump inhibitor administration. Results A total of 83 Korean patients were included (mean age 46 ± 14 years, females 61.4%). The internal consistency of the 19-item SEQ-GERD was good (alpha = 0.60–0.94) and the test–retest reliability was high (intra-class correlation coefficient = 0.67–0.95). The SEQ-GERD highly correlated with the GERD domain of the PAGI-SYM (correlation coefficient r = 0.894, P < 0.001), the RDQ-GERD (r = 0.877, P < 0.001), and GERD-QOL (r =−0.536, P < 0.05). SEQ-GERD scores significantly varied according to the overall treatment effectiveness scale of drug responsiveness and significantly decreased after drug treatment (mean differences according to the overall treatment effectiveness scale, P = 0.020). Conclusion This study supports that SEQ-GERD is reliable and valid, and can be used to evaluate the treatment response in patients with GERD.
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Affiliation(s)
- Hye-Kyung Jung
- Department of Internal Medicine, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Myung-Gyu Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myung-Ki Baek
- Department of Internal Medicine, College of Medicine, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea
| | - Justin C Y Wu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong
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