Differentiation therapy for non-acidic gastroesophageal reflux disease


Cite item

Full Text

Abstract

Aim. To investigate the clinical and pathogenetic features of the non-acidic types of gastroesophageal reflux disease (GERD) and to evaluate the impact of combined therapy versus monotherapy on the course of this disease. Subjects and methods. The investigation enrolled 62 patients with non-acidic GERD. The follow-up period was 6 weeks. The patients were divided into 2 groups: 1) weakly acidic gastroesophageal refluxes (GER); 2) weakly alkaline GER. Then each group was distributed, thus making up 4 groups: 1) 19 patients with weakly acidic GER who received monotherapy with rabeprazole 20 mg/day; 2) 21 patients with weakly acidic GER had combined therapy with rabeprazole 20 mg and itopride; 3) 8 patients with weakly alkaline GER who received ursodeoxycholic acid (UDCA) monotherapy; and 4) 14 patients with weakly alkaline GER who had combined therapy with UDCA and itopride, The clinical symptoms of the disease, the endoscopic pattern of the upper gastrointestinal tract (GIT) mucosa, histological changes in the esophageal and gastric mucosa, and the results of 24-hour impedance pH monitoring were assessed over time. Results. During differentiation therapy, the majority of patients reported positive clinical changes and an improved or unchanged endoscopic pattern. Assessment of impedance pH monitoring results revealed decreases in the overall number of GERs, the presence of a bolus in the esophagus, and the number of proximal refluxes. These changes were noted not only in patients taking proton pump inhibitors (PPIs), but also in those treated with UDCA monotherapy or combined PPI and prokinetic therapy. Conclusion. A differentiated approach to non-acidic GER treatment contributes to its efficiency. Adding the prokinetic itomed (itopride hydrochloride) to PPI therapy in a patient with weakly acidic GER enhances the efficiency of treatment, by positively affecting upper GIT motility. The mainstay of therapy for GERD with a predominance of weakly alkaline refluxes is UDCA, the combination of the latter and the prokinetic can exert a more pronounced effect on the clinical and endoscopic pattern and upper GIT motility.

About the authors

N B Lishchuk

ГБОУ ВПО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России

Санкт-Петербург, Россия

V I Simanenkov

ГБОУ ВПО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России

Санкт-Петербург, Россия

S V Tikhonov

ГБОУ ВПО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России

Санкт-Петербург, Россия0

References

  1. Vakil N, van Zanden, Kahrilas P, Dent J, Jones R. The Monreal definition and classification of gastroesophageal reflux disease: A global evidence-based consensus. Am J Gastroenterol. 2006;101: 1900-1920. doi: 10.1111/j.1572-0241.2006.00630.x
  2. Bate CM. Cost effectiveness of treatment for gastro-oesophageal reflux disease in clinical practice. Gut. 1998;43(5):729-730. doi: 10.1136/gut.43.5.728
  3. Dent J, Brun J, Fendrick AM, Fennerty MB, Janssens J, Kahrilas PJ, Lauritsen K, Reynolds JC, Shaw M, Talley NJ. An evidence-based appraisal of reflux disease management — the Genval Workshop Report. Gut. 1999;44(2):S1-S16. doi: 10.1136/gut.44.2008.S1
  4. Quigley EM. Factors that influence therapeutic outcomes in symptomatic gastroesophageal reflux disease. Am J Gastroenterol. 2003;98(3):S24-S30. doi: 10.1016/S0002-9270(03)00012-1
  5. Brady WM, Ogorec CP. Gastroesofageal reflux disease. The long and the short of therapeutic options. Postgrad Med. 1996; 100(5):76-94. doi: 10.3810/pgm.1996.11.110
  6. Betzer P. Goals of therapy and guidelines for treatment success in symptomatic gastroesophageal reflux disease patients. Am J Gastroenterol. 2003;98(3):S31-S39. doi: 10.1016/S0002-9270(03)00013-3
  7. Vaezi MF. Refractory GERD: acid, nonacid, or not GERD? Am J Gastroenterol. 2004;99(6):981-988. doi: 10.1111/j.1572-0241.2004.04166.x
  8. Richter J. The patient with refractory gastroesophageal reflux disease. Dis Esophagus. 2006;19(6):443-447. doi: 10.1111/j.1442-2050.2006.00619.x
  9. Cicala M, Emerenziani S, Guarino MP, Ribolsi M. Proton pump inhibitor resistance, the real challenge in gastro-esophageal reflux disease. Word J Gastroenterol. 2013;19(39):6529-6535. doi: 10.3748/WJG.v19.i39.6529
  10. Moraes-Filbo JP. Refractory gastroesophageal reflux disease. Arq Gastroenterol. 2012;49(4):296-301. doi: 10.1590/S0004-28032012000400012
  11. Silny J. Intraluminal multiple electric impedance procedure for measurement of gastrointestinal motility. J Gastrointest Motil. 1991;3:151-162. doi: 10.1111/j.1365-2982.1991.tb00061.x
  12. Гриневич В.Б. Мониторинг рН, желчи и импедансомониторинг в диагностике ГЭРБ. Эксперим. и клин. гастроэнтерология. 2004;6:119-121.
  13. Кайбышева В.О., Сторонова О.А., Трухманов А.С., Ивашкин В.Т. Возможности внутрипищеводной рН-импедан-сометрии в диагностике ГЭРБ. РЖГГК. 2013;2:4-16.
  14. Sifrim D, Dupont L, Blondeau K, Zhang X, Tack J, Janssens J. Weakly acidic reflux in patients with chronic unexplained cough during 24 hour pressure, pH, and impedance monitoring. Gut. 2005;54:449-454. doi: 10.1136/gut.2004.055418
  15. Boeckxstaens GE, Smout A. Systematic review: Role of acid, weakly acidic and weakly alkaline reflux in gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2010;32:334-343. doi: 10.1111/j.1365-2036.2010.04358.x
  16. Маев И.В., Дичева Д.Т., Андреев Д.Н. Подходы к индивидуализации лечения гастроэзофагеальной рефлюксной болезни. Эффективная фармакотерапия. Гастроэнтер. 2012;4:18-22.
  17. Маев И.В., Дичева Д.Т., Андреев Д.Н. Возможности терапии гастроэзофагеальной рефлюксной болезни. Мир фармации и медицины. 2013;2:9-14.
  18. Маев И.В., Гуленченко Ю.С., Анреев Д.Н., Казюлин А.Н., Дичева Д.Т. Дуоденогастроэзофагеальный рефлюкс: клиническое значение и подходы к терапии. Consiliummedicum. 2014;8:5-8.
  19. Андреев Д.Н., Кучерявый Ю.А Перспективы лечения гастроэзофагеальной рефлюксной болезни. Consiliummedicum. 2013;2:9-14.
  20. Трухманов А.С. Гастроэзофагеальная рефлюксная болезнь: клиника, диагностика, лечение. Российский медицинский журнал.Болезни органов пищеварения. 2003;3(1):22-26.
  21. Namiot Z, Saroseik J, Marcinkiewicz M, Edmunds MC, McCallum RW. Declined human esophageal mucin secretion in patients with severe reflux esophagitis. Dig Dis Sci. 1994;39:2523-2529. doi: 10.1007/BF02087685
  22. Yaron Niv, Ronnie Fass. The role of mucin in GERD and its complication. Gastroenter Hepatol. 2011;9(1):55-59. doi: 10.1038/nrgastro.2011.211
  23. Frieling T. Anti reflux therapy — more than acid reduction. Internist. 2004;45:1364. doi: 10.1007/s00108-004-1291-7
  24. Goldblum JR. Barrett’s Esophagus and Barrett’s-Related Dysplasia. Mod Pathol. 2003;16(4):316-324. doi: 10.1097/01.mp.0000062996.66432.12
  25. Vela MF, Camacho-Lobato L, Srinivasan R, Radu Tutuian, Philip O Katz, Donald O Castell. Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: effect of omeprazole. Gastroenterology. 2001;120:1599-1606. doi: 10.1053/gast.2001.24840
  26. Маев И.В., Андреев Д.Н., Дичева Д.Т. Гастроэзофагеальная рефлюксная болезнь: от патогенеза к терапевтическим аспектам. Consilium medicum. 2013;8:30-36.
  27. Vaezi MF, Richter JE. Synergism of acid and duodenogastroesophageal reflux in complicated Barrett’ esophagus. Surgery. 1995;117:699-704. doi: 10.1016/S0039-6060(95)80015-8
  28. Vaezi MF. Refractory GERD: acid, nonacid, or not GERD? Am J Gastroenterol. 2004;99(6):981-988. doi: 10.1111/j.1572-0241.2004.04166.x
  29. Talley NJ, Tack J, Ptak T, Gupta R, Giguereet M. Itopride in functional dyspepsia: results of two phase III multicentre, randomised, double-blind, placebo-controlled trials. Gut. 2008; 57(6):740-746. doi: 10.1136/gut.2007.132449.
  30. Маев И.В., Дичева Д.Т., Андреев Д.Н., Андреев Н.Г., Гуртовенко И.Ю., Биткова Е.Н. Терапевтическая роль прокинетических препаратов в лечении гастроэзофагеальной рефлюксной болезни. Медицинский совет. 2014;4:66-70.
  31. Rocha MS, Herbella FA, Del Grande JC, Ferreira AT. Effects of ursodeoxycholic acid in esophageal motility and the role of the mucosa. An experimental study. Dis Esophagus. 2011;24(4):291-294. doi: 10.1111/j.1442-2050.2010.01137.x
  32. Бабак О.Я. Желчный рефлюкс: методы патогенетической терапии. Здоровье Украины. 2006;5:25-26.
  33. Лазебник Л.Б., Ильченко Л.Ю., Голованов Е.В. Урсодезоксихолевая кислота. К 100-летию обнаружения. Consiliummedicum. 2002;2:10-14.
  34. Практическое руководство по заболеванию желчных путей. Под ред. Лейшнер У. М.: Издательство ГЭОТАР Медицина; 2001.
  35. Amaral JD, Viana RJ, Ramalbo RM Steer CJ, Rodrigues CMP. Bile acids: regulation of apoptosis by ursodeoxycholic acid. J Lipid Res. 2009;50(9):1721-1734. doi: 10.1194/jlr.R900011-JLR200
  36. Khare S, Cerda S, Wali K, FC Von Lintig, Tretiakova M, Stoiber D, Cohen G, Nimmagadda K, Hart J, Sitrin M, Boss GR, Bissonnette M. Ursodeoxycholic acid inhibits Ras mutations, wild-type Ras activation, and cyclooxygenase-2 expression in colon cancer. Cancer Res. 2003;63(13):3517-3523. doi: 10.1016/S0016-5085(03)83066-4
  37. Kurtz W, Haddad A, Phillips SF. Chenodeoxycholic and ursodeoxycholic acids alter motility and fluid transit in the canine ileum. Digestion. 1986;34(3):185-195. doi: 10.1159/000199328

Copyright (c) 2017 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies