Brief Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jul 21, 2011; 17(27): 3235-3241
Published online Jul 21, 2011. doi: 10.3748/wjg.v17.i27.3235
Influence of irritable bowel syndrome on treatment outcome in gastroesophageal reflux disease
Hubert Mönnikes, Robert C Heading, Holger Schmitt, Hubert Doerfler
Hubert Mönnikes, Department of Medicine, Martin-Luther Hospital, Academic Teaching Hospital of Charité, Universitätsmedizin, 14193 Berlin, Germany
Robert C Heading, Edinburgh, EH10 7AR, Scotland, United Kingdom
Holger Schmitt, Nycomed GmbH, 78467 Constance, Germany
Hubert Doerfler, Nycomed International Management GmbH, 8152 Zurich, Switzerland
Author contributions: Mönnikes H, Heading RC, Schmitt H and Doerfler H were all involved in the study concept and design, analysis and interpretation of data, and the critical revision of the manuscript for important intellectual content; all provided approval of the final manuscript. Additionally, Mönnikes H took a lead role in drafting of the manuscript. Schmitt H and Doerfler H provided administrative, technical, and material support, and were responsible for study supervision.
Supported by Nycomed GmbH
Correspondence to: Hubert Mönnikes, MD, PhD, Department of Medicine, Martin-Luther Hospital, Academic Teaching Hospital of Charité, 14193 Berlin, Germany. moennikes@web.de
Telephone: +49-30-89553100  Fax: +49-30-89554554
Received: November 22, 2010
Revised: February 12, 2011
Accepted: February 19, 2011
Published online: July 21, 2011
Abstract

AIM: To investigate the influence of irritable bowel syndrome (IBS)-like symptoms on treatment outcomes with pantoprazole in gastroesophageal reflux disease (GERD) in a real life setting.

METHODS: For this prospective, open-label, multinational, multicentre study, 1888 patients assessed by the investigators as suffering from GERD were recruited. The patients were additionally classified as with or without IBS-like symptoms at baseline. They were treated with pantoprazole 40 mg once daily and completed the Reflux Questionnaire™ (ReQuest™) short version daily. Response rates and symptom scores were compared after 4 and 8 wk of treatment for subgroups defined by the subclasses of GERD [erosive (ERD) and non-erosive reflux disease (NERD)] and the presence of IBS-like symptoms.

RESULTS: IBS-like symptoms were more prevalent in NERD than in ERD (18.3% vs 12.7%, P = 0.0015). Response rates after 4 and/or 8 wk of treatment were lower in patients with IBS-like symptoms than in patients without IBS-like symptoms in both ERD (Week 4: P < 0.0001, Week 8: P < 0.0339) and NERD (Week 8: P = 0.0088). At baseline, ReQuest™“lower abdominal complaints” symptom scores were highest in NERD patients with IBS-like symptoms. Additionally, these patients had the strongest symptom improvement after treatment compared with all other subgroups.

CONCLUSION: IBS-like symptoms influence treatment outcome and symptom burden in GERD and should be considered in management. Proton pump inhibitors can improve IBS-like symptoms, particularly in NERD.

Keywords: Pantoprazole; ReQuestTM; Clinical practice; Irritable bowel syndrome; Gastroesophageal reflux disease