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Double-dosed pantoprazole accelerates the sustained symptomatic response in overweight and obese patients with reflux esophagitis in Los Angeles grades A and B
- Source :
- The American journal of gastroenterology. 105(5)
- Publication Year :
- 2009
-
Abstract
- Body mass index (BMI) in the range defined as overweight or obese adversely decreases the sustained symptomatic response (SSR) to proton pump inhibitors for patients with reflux esophagitis of Los Angeles grade A or B (RE-AB). We thus investigated whether double-dosed pantoprazole can accelerate SSR in such patients.A total of 200 overweight or obese patients with RE-AB were evenly randomized into a double-dosed group (receiving 8-week pantoprazole 40 mg twice daily) or a standard-dosed control group (receiving 8-week pantoprazole 40 mg per day and one blank tablet at night). In each patient, demographic factors and the genotype of S-mephenytoin 4'-hydroxylase (CYP2C19) were checked and defined as poor metabolizer (PM), or homologous extensive metabolizer (HomoEM), or heterologous extensive metabolizer (HeteroEM). The cumulative proportions of patients with SSR were compared during the 8-week period.Both intention-to-treat and per-protocol analyses disclosed that the rates of SSR were higher in the double-dosed group than in the standard-dosed group from week 4 (P=0.005) until week 8 (P=0.01). While using standard-dosed pantoprazole, PMs had better rates of SSR during the 8-week period than both HomoEMs and HeteroEMs (P0.05). By using double-dosed pantoprazole, the cumulative rates of SSR were improved as early as week 4 for both HomoEMs and HeteroEMs (P0.005, log-rank test).For RE-AB in overweight and obese patients, double-dosed pantoprazole effectively accelerates the SSR, especially for those with CYP2C19 genotypes as HeteroEM or HomoEM. Accordingly, it offers an earlier shift into on-demand pantoprazole for RE-AB patients with high BMI.
- Subjects :
- Adult
Male
medicine.medical_specialty
Kaplan-Meier Estimate
Overweight
Gastroenterology
Risk Assessment
Severity of Illness Index
2-Pyridinylmethylsulfinylbenzimidazoles
Drug Administration Schedule
Statistics, Nonparametric
Body Mass Index
Pharmacotherapy
Internal medicine
Severity of illness
Medicine
Humans
Obesity
Prospective Studies
Reflux esophagitis
Prospective cohort study
Esophagitis, Peptic
Pantoprazole
Aged
Probability
Hepatology
Dose-Response Relationship, Drug
business.industry
Middle Aged
medicine.disease
Los Angeles
Treatment Outcome
Gastroesophageal Reflux
Female
medicine.symptom
business
Esophagitis
Body mass index
medicine.drug
Follow-Up Studies
Subjects
Details
- ISSN :
- 15720241
- Volume :
- 105
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- The American journal of gastroenterology
- Accession number :
- edsair.doi.dedup.....a76b5bdc60554e8548f05ac3c6bd6d71