Observational comparative trial of the efficacy of proton pump inhibitors versus histamine-2 receptor antagonists for uninvestigated dyspepsia

Background and Aims: It is still controversial which drugs, proton pump inhibitors (PPI) or histamine‐2 receptor antagonists (H2RA), are more effective for dyspepsia in the Japanese population. Methods: Patients with uninvestigated dyspepsia (n = 104; male/female 41/63) were treated with either rabeprazole 10 mg o.d. (n = 62) or lafutidine 10 mg b.i.d. (n = 42) for 4 weeks. Questionnaires (modified Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease [mFSSG] and quality of life [QOL], SF‐8) were administered before and after therapy. The mFSSG was classified into a total score (Q‐T), reflux score (Q‐R), dyspepsia score (Q‐D) and pain score (Q‐P). The SF‐8 had a physical component summary (PCS) and mental component summary (MCS). The predominant type of symptom was reflux (R‐S), pain (P‐S) or dysmotility (D‐S). Results: R‐S was 19.2%, P‐S 48.1%, D‐S 24.0% and overlap 8.7%. In the R‐S, Q‐T and Q‐R significantly improved with rabeprazole, but neither scale improved with lafutidine. MCS significantly improved with rabeprazole. In P‐S, Q‐T, Q‐R, Q‐D and Q‐P significantly improved with both drugs. PCS significantly improved with both, whereas the MCS significant improved with rabeprazole. In D‐S, Q‐R and Q‐D significant improved with rabeprazole, but neither improved with lafutidine. QOL did not improve with either. With overlap, neither scale nor the QOL reached a significant difference. Conclusion: Both PPI and H2RA have a positive effect on P‐S, but H2RA therapy is limited for R‐S and D‐S, whereas PPI therapy is generally effective. Therefore, careful prescription based on symptoms is important.