Gastroesophageal reflux disease: Treatment options are beyond the proton pump inhibitors.

Abstract

Objectives: To observe the effects of different combinations of medicines in GERD patients by using FSSG score. Study Design: Observational Study. Setting: Al-Tibri Medical College Hospital, Isra University Karachi Campus Karachi. Period: June 2017 to December 2017. Material & Methods: The study was conducted on GERD patients at Tertiary Care Hospital of Karachi. Adult patients from male and female gender with clinical symptoms suggestive of GERD were included. During clinical history taking patients were interviewed to respond symptoms frequency of FSSG questionnaire score from 0 to 4 on each question. All 154 eligible patients enrolled in the study and divided into three groups Group I (PPI alone), Group II (PPI with prokinetic) and Group III (PPI, prokinetic and SSRI). After 2 weeks of treatment, FSSG score of every participant was calculated. Results: Results of 134 patients 72 (53.3%) males and 63 (46.7%) females were analyzed. The cumulative mean age was 37.12±8.221 (range 16 – 60) years. The patients were grouped by single blind randomization method, each group I and group II consisted of 45 subjects and 44 patients were enrolled in group III. The mean FSSG score prior to treatment and after treatment was 21.194±4.786 and 14.962±3.696 respectively, hence, the gradient of pre-treatment and post-treatment was 6.231±4.601. The three groups shown significant improvement in FSSG score after treatment but the group III had shown highest improvement in mean FSSG score of 7.522±3.592, followed by group II with 7.2889±3.805and group I had shown the lowest improvement of 3.911±5.346 but statistical analysis revealed these improvements within each group as insignificant while turned to be significant when groups were analyzed with each other. (p 0.003). Conclusion: The results of this study suggests that PPIs alone have good therapeutic role but as dysmotility aspect of GERD and psychological comorbidity is very common in those patients and is likely to play an important role in response, or failure of response, to proton pump inhibitor treatment. Hence, addition of prokinetic and anxiolytics can augment the response rate.