Patients who indicated concomitant symptoms on the Reflux Disease Questionnaire experienced a reduced effect from acid-suppression medications in a recent study.
Researchers re-evaluated data from two randomized trials comparing esomeprazole and acid suppressor AZD0865 in 1,460 patients with nonerosive reflux disease (NERD) and 1,514 with reflux esophagitis (RE). All patients experienced moderate to severe substernal burning (SB), and study results indicated no difference between the drugs in treatment response to this symptom. All participants completed the Reflux Disease Questionnaire (RDQ) upon inclusion.
Overall 48% of the patients with NERD and 55% of those with RE reported complete resolution of their SB symptoms. SB was indicated as the only symptom by 3.3% of patients, and these participants were more likely to experience an improvement compared with those reporting additional symptoms in both the NERD (OR=1.41; 95% CI, 0.76-2.62) and RE (OR=1.76; 95% CI, 0.80-3.85) groups.
Patients reported an average of four symptoms on the RDQ. Apart from reported symptoms of “regurgitation-taste,” any symptom indicated on the RDQ in addition to SB was associated with reduced treatment efficacy. In particular, patients with RE who reported severe pain (OR=0.20, 95% CI) or burning (OR=0.33, 95% CI) from dyspepsia were less likely to experience improved SB symptoms. Dyspepsia symptoms also responded poorly to treatment, with 29% of patients with NERD and 34% of patients with RE experiencing an improvement.
“Patients with GERD who had the greatest symptom burden at presentation, as assessed by the number of positive RDQ responses, had the lowest likelihood of a complete response to acid-suppressive therapy,” the researchers wrote. “One potentially important implication of this is that more emphasis should be placed on the presence and treatment response of symptoms other than [SB]. This would necessitate the use of a disease-specific symptom questionnaire … to provide a more comprehensive assessment of disease state and treatment response.”
Disclosure: See the study for a full list of relevant disclosures.