Rabeprazole is effective in treating laryngopharyngeal reflux in a randomized placebo-controlled trial.

BACKGROUND & AIMS: There is controversy about the efficacy of treating patients with laryngopharyngeal reflux (LPR) using proton pump inhibitors (PPIs). We assessed the effects of high doses of the PPI rabeprazole in patients with LPR. METHODS: Patients with LPR symptoms were assigned randomly to receive rabeprazole (20 mg, twice daily, n = 42) or placebo (n = 40) for 12 weeks. All patients completed symptom questionnaires; these provided demographic information and the reflux symptom index before, during, and 6 weeks after cessation of treatment. Videolaryngostroboscopy was used to document the laryngeal findings and determine the reflux finding score. RESULTS: Twenty-four patients (57.1%) in the rabeprazole group and 27 patients (67.5%) in the placebo group had pH-documented LPR. The total reflux symptom index score decreased significantly in the group given rabeprazole, compared with patients given placebo, at weeks 6 and 12, but not at week 18. However, there were no significant differences in reflux finding scores between the rabeprazole and placebo groups at any of the time points. CONCLUSIONS: Twelve weeks of treatment with rabeprazole (20 mg, twice daily) significantly improved reflux symptoms, compared with placebo, in patients with LPR. Relapse of symptoms was observed 6 weeks after stopping PPI therapy, indicating the requirement for longer treatment duration in patients with LPR.

Reflux profile of Chinese gastroesophageal reflux disease patients with combined multichannel intraluminal impedance-pH monitoring.

BACKGROUND AND AIMS: To investigate the reflux profile of Chinese gastroesophageal reflux disease (GERD) patients with the aid of combined multichannel intraluminal impedance-pH (MII-pH) monitoring technique. METHODS: Consecutive patients presented with GERD symptoms were enrolled to erosive esophagitis (EE) group, non-erosive reflux disease (NERD) group and functional heartburn (FH) group after upper endoscopy, combined MII-pH monitoring and rabeprazole test. Another 20 healthy controls (HC) were recruited. RESULTS: Sixty-four GERD patients (EE:20, NERD:22, FH:22, HC:20) were enrolled. There were more episodes of liquid reflux and proximal reflux in EE and NERD groups than that in FH and HC groups (P < 0.05). Patients in FH and HC groups had higher proportion of mixed reflux (P = 0.000). The percentage of acid reflux in EE and NERD was much higher, while there was a higher percentage of weakly acidic reflux in FH and HC (P = 0.000). No significant difference was found in MII-pH parameters between groups with and without response to rabeprazole test except recumbent percentage time of esophageal pH value below 4 and episodes of proximal reflux. CONCLUSION: Erosive esophagitis and NERD patients had more liquid and proximal reflux episodes than FH patients and healthy controls. Acid and liquid reflux was predominant in the former two groups, while weakly acidic and mixed reflux was predominant in the latter two groups.

Normal values of 24-hour combined esophageal multichannel intraluminal impedance and pH monitoring in the Chinese population.

BACKGROUND: There is a lack of data on combined esophageal multichannel intraluminal impedance and pH (MII-pH) monitoring in the Chinese population. GOALS: To define the normal range and compare the parameters to those of the Western population. STUDY: Healthy volunteers were recruited and underwent 24-hour ambulatory combined MII-pH monitoring. Gastroesophageal reflux episodes were detected and characterized by pH (acidic, weakly acidic and weakly alkaline reflux) and composition (liquid, mixed and gas reflux). RESULTS: Seventy healthy volunteers (male:female 33:37) were recruited. The median and 95th percentile number of the total reflux episodes over 24 h in the Chinese population was 40 and 75, respectively, whereas the corresponding numbers of acidic, weakly acidic and weakly alkaline reflux episodes were 22 and 54, 16 and 40, and 0 and 4, respectively. Among all reflux episodes 53.3% were acidic, 44.7% were weakly acidic, and 2% weakly alkaline. More than half (52.4%) of the reflux episodes were mixed, 37.2% were liquid, and 10.4% were gas. A total of 26.6% of reflux episodes reached 15 cm above the lower esophageal sphincter. Male gender was associated with an increased number of acid, liquid, mixed and proximal reflux episodes (p < 0.05). CONCLUSIONS: This study provides normal values for the Chinese population. Differences between genders in impedance parameters required caution during data interpretation. The number of reflux episodes in the Chinese population was similar to that in the Western population.

Gastro-oesophageal reflux disease in Asia : birth of a 'new' disease?

Gastro-oesophageal reflux disease (GORD) is one of the most common gastrointestinal diseases in the Western world and imposes a heavy burden on society. Although its prevalence in Asia is much lower, there is evidence that this is rapidly rising in Asia. The reported population prevalence of GORD in Eastern Asia ranges from 2.5% to 6.7% for at least weekly symptoms of heartburn and/or acid regurgitation. In general, Asians tend to have a milder spectrum of the disease. Most Asian patients have non-erosive GORD; erosive oesophagitis is less commonly seen than in the Western population. Complicated GORD, such as oesophageal stricture and Barrett's oesophagus, is seldom encountered. The mechanisms of GORD may be different in the Chinese population compared with the Western population. Chest pain is the most predominant extra-oesophageal manifestation of GORD in China, whereas an association with asthma has been shown in Japanese patients. The prevalence of GORD appears to be increasing and possible factors for GORD in Asian populations include Helicobacterpylori infection, obesity and increasing dietary fat intake. The adoption of a Western lifestyle in many developing Asian countries may account for the increasing prevalence of GORD. Proton pump inhibitors remain the most effective medical treatment for GORD. GORD will undoubtedly be a great challenge to clinicians both in primary care and in gastroenterology practice in the Asia-Pacific region in the coming years.

Treatment of non-erosive reflux disease with a proton pump inhibitor in Chinese patients: a randomized controlled trial.

BACKGROUND: Evidence suggests that rates of gastroesophageal reflux disease are increasing in the Asia-Pacific region, where patients tend to have predominantly non-erosive reflux disease as opposed to erosive (reflux) esophagitis. At present, data for the responsiveness of non-erosive reflux disease to proton pump inhibition are scant. We aimed to study esomeprazole for the treatment of non-erosive reflux disease in Chinese patients. METHODS: Patients with a clinical diagnosis of gastroesophageal reflux, and a locally validated reflux index, the Chinese GerdQ, of equal to or greater than 12 were recruited and randomized to receive esomeprazole 20 mg daily or placebo for 8 weeks. Reflux index scores, quality of life (SF-36), and the hospital anxiety and depression (HAD) scale and symptom relief were evaluated before, during, and after treatment. RESULTS: A total of 175 patients were randomized. Patients in the esomeprazole group (n = 85) demonstrated statistically significant reductions in their GerdQ index, from 19.45 to 15.37 and to 14.32 (p = 0.013, p = 0.005) at weeks 4 and 8, respectively. Compared to placebo at week 8, 57.1% of patients on esomeprazole found that their symptoms had resolved or were acceptable compared with 37.2% in the placebo group (p = 0.001). There were no statistically significant differences in overall quality-of-life measures or the HAD scale related to treatment. CONCLUSIONS: This study suggests that esomeprazole is efficacious in treating Chinese patients with non-erosive reflux disease.