TOES Evaluations of Abstracts Submitted for the 69th Annual Scientific Meeting of the American College of Gastroenterology
American Journal of Gastroenterology, Vol. 99, No. 10, Suppl., 2004, ©2004 by Am. Coll. of Gastroenterology, ISSN 0002-9270/04/xx.xx, Published by Blackwell Publishing
October 29–November 3, 2004, Orlando, Florida
IS TWICE A DAY PPI BETTER THAN ONCE A DAY PPI FOR THE TREATMENT OF GERD RELATED ENT SYMPTOMS?
Woosuk Park, M.D., et al. Am J Gastro 2004:99 Suppl; A78.
Evidence-based info : Open-labeled cohort study
Type of Study : Independent
Sample size : n = 85
Background : It is thought that BID ppi is better than QD PPI for control of Atypical GERD symptoms (hoarseness, sore throat, etc.)
Primary finding : BID is better. But still only 50% of patients reported improvement on BID PPI. H2 blocker added to BID treatment didn't make a difference. Nexium 40mg® QD did not work as well as Omeprazole 20 bid or Lansoprazole 30 bid. Those patients on Nexium® 40 QD who were switched to Lanso 30 bid did better with regard to atypical symptoms.
Score of Study (TOES): = 20 out of 100
Is it consistent with what we already know? – Yes
How should this effect your practice?
- Patient's with atypical symptoms only have 50% response rate to delayed release PPIs given BID.
- Delayed release PPIs work better at controlling esophageal pH when given more times per day rather than increasing the dose and giving them once per day. (also see Nexium in Barrett's abstract)
- If your patient has atypical symptoms, and you are using a delayed-release PPI then give it twice a day – but only half of them will have significant relief of atypical symptoms.