Treatment with acid suppression may have a greater impact on heartburn symptoms than regurgitation in patients with GERD, according to recent results.
In a retrospective analysis, researchers evaluated data pooled from two randomized controlled trials wherein 1,460 patients with nonerosive reflux disease (NERD) and 1,514 patients with reflux esophagitis (RE) received between 25 mg/day and 75 mg/day of acid blocker AZD0865 or between 20 mg/day and 40 mg/day of esomeprazole for 4 weeks. All participants indicated substernal burning as their primary symptom, and had been experiencing it for more than 6 months. The study was designed to determine the impact of acid suppression on regurgitation compared with heartburn symptoms.
At baseline 93% of participants reported either an acid taste (regurgitation taste) or a feeling of material moving upward from the stomach (regurgitation movement). One or both of these symptoms were severe in 717 patients with NERD (53%) and in 751 patients with RE (54%), and those with severe symptoms were less responsive to treatment than patients with RE or with NERD and substernal burning.
Patients with NERD reported 48.5% responsiveness for substernal burning (95% CI, 45.6-51.3), 34.3% for regurgitation taste (95% CI, 30.1-38.5) and 26.0% for regurgitation movement (95% CI, 21.5-30.5). Patients with RE indicated 54.9% responsiveness for substernal burning (95% CI, 51.5-58.2), 43.9% for regurgitation taste (95% CI, 38.8-49.1) and 32.8% for regurgitation movement (95% CI, 27.3-38.4). Patients indicating relief from severe regurgitation movement symptoms were significantly fewer than those experiencing relief from regurgitation taste symptoms in the RE group, with a similar trend observed in the NERD group.
“High severity regurgitation, particularly when perceived as ‘unpleasant movement of material upwards from the stomach,’ was much less responsive to potent acid suppression than was heartburn in both NERD and RE patients,” the researchers concluded. “These observations reinforce previous reports that persistent regurgitation is a significant contributor to partial response to [proton pump inhibitor] therapy in GERD.”