PMID- 36649678 OWN - NLM STAT- MEDLINE DCOM- 20230804 LR - 20230804 IS - 1421-9867 (Electronic) IS - 0012-2823 (Linking) VI - 104 IP - 4 DP - 2023 TI - Examination on Factors Affecting Symptom Change after Drug Withdrawal in Patients with Mild Erosive Gastroesophageal Reflux Disease Undergoing Symptom-Controlled Maintenance Therapy with Acid-Secretion Inhibition Drugs. PG - 270-282 LID - 10.1159/000528418 [doi] AB - INTRODUCTION: In patients with gastroesophageal reflux disease (GERD) on maintenance therapy with acid-suppressive drugs, it is not clear what background factors allow patients to discontinue the drugs. The aims of this study were to examine the relationship of the changes in the frequency and severity of gastrointestinal symptoms after discontinuation of acid-secretion inhibitors for erosive GERD (eGERD) with possible patient background factors and to identify factors that influence these changes. METHODS: This is a multicenter, open-label, interventional, exploratory study. eGERD patients with mild mucosal injury whose symptoms were under control and who were on maintenance therapy with acid-suppressive drugs were withdrawn from the drug treatment for 4 weeks. We examined the relationship of patient backgrounds (sex, age, body mass index, alcohol consumption, smoking habits), esophageal hiatal hernia, Helicobacter pylori infection, pepsinogen I and II concentrations and I/II ratios, blood gastrin levels before and after drug discontinuation with total score change in Frequency Scale for the Symptoms of GERD (FSSG). RESULTS: Of the 92 patients whose symptoms could be assessed before and after drug withdrawal, 66 patients (71.7% of the total) had FSSG <8 and no symptom relapse after the withdrawal. Furthermore, patient background factors that may be related to symptom relapse/non-relapse were examined, but no related factors were detected. The maintenance medications before discontinuation in the above 92 patients were a proton pump inhibitor (PPI) and vonoprazan (VPZ, a potassium ion competitive acid blocker). Since PPI and VPZ were administered to about the same number of patients, though incidentally, we additionally examined the relationship between patient background factors and symptom relapse/non-relapse by treatment group. As a result, no relevant background factors were detected in both groups. Although there were no significant differences between the two groups, the severity and frequency of symptom recurrence in the VPZ group tended to be higher than in the PPI group. CONCLUSIONS: Consideration of background factors is unlikely to be required in the discontinuation of maintenance therapy for eGERD. There was no significant difference in the extent of disease or frequency of recurrence during the discontinuation period, regardless of whether the drug before discontinuation was a PPI or VPZ. CI - (c) 2023 S. Karger AG, Basel. FAU - Tanaka, Hironori AU - Tanaka H AD - 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan. FAU - Takeuchi, Toshihisa AU - Takeuchi T AD - Endoscopic Centre, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Japan. FAU - Nishida, Shinya AU - Nishida S AD - Endoscopic Centre, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Japan. FAU - Hongo, Hitosi AU - Hongo H AD - Fujita Gastroenterological Hospital, Osaka, Japan. FAU - Takii, Michiaki AU - Takii M AD - Osaka Medical and Pharmaceutical University Mishima-Minami Hospital, Takatsuki, Japan. FAU - Higashino, Takeshi AU - Higashino T AD - Shiroyama Hospital, Habikino, Japan. FAU - Sanomura, Makoto AU - Sanomura M AD - Hokusetsu General Hospital, Takatsuki, Japan. FAU - Miyazaki, Hirota AU - Miyazaki H AD - Hanwasumiyoshi General Hospital, Osaka, Japan. FAU - Hoshimoto, Masahiro AU - Hoshimoto M AD - Seikeikai Hospital, Sakai, Japan. FAU - Kimura, Tsuguhiro AU - Kimura T AD - Fujita Gastroenterological Hospital, Osaka, Japan. FAU - Sakaguchi, Masahiro AU - Sakaguchi M AD - Department of Internal Medicine, Moriguchi Keijinkai Hospital, Moriguchi, Japan. FAU - Abe, Takashi AU - Abe T AD - Hanwasumiyoshi General Hospital, Osaka, Japan. FAU - Hakoda, Akitoshi AU - Hakoda A AD - 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan. FAU - Sugawara, Noriaki AU - Sugawara N AD - 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan. FAU - Iwatsubo, Taro AU - Iwatsubo T AD - 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan. FAU - Kawaguchi, Shinpei AU - Kawaguchi S AD - 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan. FAU - Ota, Kazuhiro AU - Ota K AD - 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan. FAU - Kojima, Yuichi AU - Kojima Y AD - Endoscopic Centre, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Japan. FAU - Higuchi, Kazuhide AU - Higuchi K AD - 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20230117 PL - Switzerland TA - Digestion JT - Digestion JID - 0150472 RN - 0 (Proton Pump Inhibitors) SB - IM MH - Humans MH - *Helicobacter Infections/drug therapy MH - *Helicobacter pylori MH - *Gastroesophageal Reflux/drug therapy/diagnosis MH - *Hernia, Hiatal MH - Proton Pump Inhibitors/adverse effects MH - Treatment Outcome OTO - NOTNLM OT - Gastroesophageal reflux disease OT - Proton pump inhibitor OT - Rebound OT - Vonoprazan EDAT- 2023/01/18 06:00 MHDA- 2023/08/04 06:43 CRDT- 2023/01/17 18:22 PHST- 2022/07/16 00:00 [received] PHST- 2022/11/03 00:00 [accepted] PHST- 2023/08/04 06:43 [medline] PHST- 2023/01/18 06:00 [pubmed] PHST- 2023/01/17 18:22 [entrez] AID - 000528418 [pii] AID - 10.1159/000528418 [doi] PST - ppublish SO - Digestion. 2023;104(4):270-282. doi: 10.1159/000528418. Epub 2023 Jan 17.