levosulpiride and Gastroesophageal-Reflux

This prospective study was conducted to characterize the clinical features of adult rumination syndrome, in the absence of psychiatric illness, by applying newly modified clinical criteria, and to elucidate factors influencing outcomes after treatment.. Twenty-one adult patients diagnosed with rumination syndrome at a tertiary referral center over a 2-year period were enrolled in the study. All patients received supportive psychotherapy and medical treatment. Changes in symptom parameters were analyzed using a pretreatment and a post-treatment questionnaire. Patients were classified into three groups according to symptomatic outcome: improved group, sustained group and aggravated group.. The duration of treatment was longer in the improved group than in the sustained or aggravated groups (P = 0.018). Esophageal manometry testing demonstrated non-transmitted contractions of the esophageal body in 10 patients (47.6%) and low amplitude contractions in eight patients (38.1%). Mean lower esophageal sphincter (LES) pressure was 9.8 +/- 2.6 mmHg. Baseline LES pressure in the improved group was higher than in the other groups (P = 0.001). Ambulatory 24-h esophageal pH monitoring showed pathological acid reflux in six patients (28.6%). All pathological acid reflux occurred in post-rumination periods. Scintigraphic testing of gastric emptying revealed that the mean retention rate at 120 min was 34.2 +/- 2.5% of initial contents, and delayed emptying was noted in three patients (14.3%).. Rumination syndrome is often accompanied by heterogeneous conditions such as postprandial gastroesophageal reflux, various abnormalities in esophageal manometric tests and delayed gastric emptying. Medical treatment and supportive psychotherapy can be effective in otherwise normal adult patients, especially in patients who comply with long durations of treatment and who demonstrate higher baseline LES pressures.

Topics: Adult; Esophageal pH Monitoring; Esophagus; Female; Gastric Emptying; Gastroesophageal Reflux; Gastrointestinal Agents; Gastrointestinal Diseases; Humans; Male; Manometry; Muscle Contraction; Patient Education as Topic; Postprandial Period; Pressure; Prospective Studies; Psychotherapy; Sulpiride; Surveys and Questionnaires; Syndrome; Time Factors; Treatment Outcome

A relevant percentage of non-erosive reflux disease (NERD) is refractory to proton pump inhibitors (PPIs) treatment. Multichannel intraluminal impedance pH (MII-pH) monitoring should give useful pathophysiological information about refractoriness. Therefore, our aim was to assess whether this technique could be useful to guide a 'tailored' therapy in refractory NERD. We retrospectively recruited NERD patients undergoing MII-pH monitoring for unsuccessful treatment. All patients had undergone upper endoscopy, and those with erosive esophagitis were excluded. No patient received PPI during MII-pH monitoring. Subjects were subgrouped into three categories: acid reflux, non-acid reflux and functional heartburn. MII-pH-guided therapy was performed for 4 weeks as follows: patients with acid reflux received PPI at double dose, patients with non-acid reflux PPI at full dose plus alginate four times a day and patients with functional heartburn levosulpiride 75 mg per day. A visual analog scale (VAS) ranging from 0 to 100 mm was administered before and after such tailored therapy to evaluate overall symptoms. Responders were defined by VAS improvement of at least 40%. Sixty-nine patients with refractory NERD were selected (female-male ratio 43 : 26, mean age 47.6±15.2 years). Overall effectiveness of tailored therapy was 84% without statistical difference among subgroups (88.5% acid reflux, 92% non-acid reflux, 66.6% functional heartburn; P=0.06). Univariate analysis showed that therapy failure directly correlated with functional heartburn diagnosis (OR=4.60) and suggested a trend toward a negative correlation with smoking and a positive one with nausea. However, at multivariate analysis, these parameters were not significant. Functional heartburn experienced a lower median percent VAS reduction than acid reflux (52.5% versus 66.6%, P<0.01) even if equal to non-acid reflux (66.6%). In conclusion, a tailored approach to refractory NERD, guided by MII-pH monitoring, demonstrated to be effective and should be promising to cure symptom persistence after conventional therapy failure. Nevertheless, standardized guidelines are advisable.

Topics: Adult; Alginates; Anti-Ulcer Agents; Disease Resistance; Drug Therapy, Combination; Electric Impedance; Female; Gastroesophageal Reflux; Glucuronic Acid; Heartburn; Hexuronic Acids; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Proton Pump Inhibitors; Retrospective Studies; Risk Factors; Smoking; Sulpiride; Treatment Outcome