Management of symptoms in step-down therapy of gastroesophageal reflux disease

Objective: Majority of studies on gastroesophageal reflux disease (GERD) that include patients with or without erosive disease have documented the efficacy of proton pump inhibitors (PPIs) as well as their superiority to H2‐receptor antagonist (H2‐RA). The purpose of this study was to clarify the difference in quality of GERD treatment with PPIs and H2‐RA in step‐down protocol using lansoprazole. Methods: Forty‐three patients with reflux esophagitis were randomly divided into three groups and assessed by severity score; group 1 received 30 mg lansoprazole initially and maintenance therapy with a standard dose H2‐RA; group 2 received 30 mg of lansoprazole initially and maintenance therapy of 15 mg lansoprazole; and group 3 received 15 mg of lansoprazole once daily for 16 weeks. If the patients experienced symptomatic recurrence while on H2‐RA, they were switched to PPI maintenance. Results: Heartburn, regurgitation and dysphagia were hardly found in any group at 8 weeks after 15 mg or 30 mg lansoprazole treatment. After 8 weeks, however, heartburn and regurgitation recurred at 50% and 78.6%, respectively, in the stepped down to famotidine group, and quality of life (QOL) was significantly impaired. Endoscopic ultrasonography (EUS) analysis showed reduction of the submucosal layer without any change in the mucosal surface in the stepped down to famotidine group. Conclusions: Step‐down lansoprazole therapy is considered very effective in terms of rapid effect, long‐term effect and high quality GERD treatment. © 2005 Blackwell Publishing Asia Pty Ltd