Korean J Gastroenterol.  2020 Jun;75(6):333-340. 10.4166/kjg.2020.75.6.333.

Therapeutic Response to 20 mg of Esomeprazole Twice Daily in Patients with Gastroesophageal Reflux Disease-related Non-cardiac Chest Pain: An Open-Label Randomized Pilot Study

• Choi JK
• Shim HI
• Shin CM
• Yoon H
• Park YS
• Kim N
• Lee DH

• KMID: 2504375
• DOI: http://doi.org/10.4166/kjg.2020.75.6.333

Abstract

Background/Aims
Non-cardiac chest pain (NCCP) is defined as recurrent angina pectoris-like pain without evidence of coronary heart disease, and is usually related to esophageal diseases, such as gastroesophageal reflux disease (GERD). Proton pump inhibitors (PPIs) are important for diagnosis and treatment. Many studies have been conducted on the use of PPIs in patients with GERD-related NCCP. In contrast to standard-dose esomeprazole, the efficacy of half-dose esomeprazole twice daily (BD) has not been established. This study compared the efficacies of the two esomeprazole regimens in GERD-related NCCP.
Methods
In this prospective, open-label study, 37 participants with GERD-related NCCP were randomized to receive either 20 mg of esomeprazole BD (n=21) (esomeprazole BD group) or 40 mg once daily (n=16) (esomeprazole once daily [OD] group) for 4 weeks. In both groups, the chest pain score, which was calculated based on the frequency and severity, was evaluated before and 2 and 4 weeks after administering the medication.
Results
The chest pain score significantly improved in both groups (p<0.001). The proportion of patients with chest pain score improvement >50% was 7.7% higher in the esomeprazole BD group than in the esomeprazole OD group (95.2% vs. 87.5%), but the difference was not significant.
Conclusions
Esomeprazole BD was as effective as esomeprazole OD in improving GERD-related NCCP. Although statistically insignificant, the percentage of patients with >50% reduction in the chest pain score was higher in the esomeprazole BD group than in the esomeprazole OD group. Large-scale studies will be needed to assess these findings further.

Keyword

Non-cardiac chest pain; Gastroesophageal reflux; Proton pump inhibitors; Esomeprazole

Figure

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  Fig. 1 Study flow diagram. BD, twice daily; OD, once daily.

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  Fig. 2 (A, B) Change in the chest pain score between baseline and 4 weeks after administration of the medication in the esomeprazole 20-mg twice-daily group and 40-mg once-daily group.

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  Fig. 3 Proportion of patients with an improvement in the chest pain score of greater than or equal to 50% of the baseline value in each group.

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