GASTROESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH FUNCTIONAL DYSPEPSIA AND CONSTIPATION PREDOMINANT IRRITABLE BOWEL SYNDROME: CLINICAL FEATURES AND EFFICACY OF LACTULOSE AND ITOPRIDE HYDROCHLORIDE

Cover Page


Cite item

Full Text

Abstract

Background: The frequent coexistence of gastroesophageal reflux disease (GERD) with functional dyspepsia (FD) and an irritable bowel syndrome (IBS) has been described in the literature. Aim: To study the specific features of GERD clinical course and diagnosis in patients with GERD in combination with FD and constipation predominant IBS (IBS-C) in comparison to patients with isolated GERD; to assess the efficacy of lactulose and itopride hydrochloride. Materials and methods: A total of 60 patients with GERD, FD (Rome criteria III), and IBS-C (Rome criteria III) and 29 patients with isolated GERD were examined. GERD diagnosis was based on clinical, endoscopic, and pH-metric criteria. For 4 weeks 10 patients with combination of non-erosive reflux disease (NERD), FD and IBS-C received lactulose monotherapy and other 10 patients received combination of lactulose with itopride hydrochloride. Clinical symptoms and pH-metric parameters were assessed before and 4 weeks after treatment. Results: Combination of GERD, FD and IBS-C was noted more frequently in women under 40 with normal body mass index (р<0.05). Classic GERD symptoms were absent in 43.4% of patients with gastrointestinal comorbidity and in 10.3% of patients with isolated GERD (р=0.004). A higher prevalence of belching and nausea was found in patients, suffering from GERD, FD and IBS-C, than in those with isolated GERD (р<0.05). After 4-week lactulose and itopride hydrochloride treatment all the patients with GERD, FD and IBS-C showed a reduction of clinical symptoms (p<0.05) and normalization of pH-metric parameters (р<0.001). Conclusion: GERD course in patients with concomitant FD and IBS-C has the following peculiarities: predominance of women, absence of classic GERD-symptoms in almost half of these patients, and frequent combination with other functional symptoms. Combination therapy with lactulose and itopride hydrochloride enables successful control of GERD and FD symptoms as well as esophageal pH normalization.

About the authors

O. V. Krapivnaya

Railroad Clinical Hospital at the Khabarovsk-1 station, JSC RRR, 49 Voronezhskaya ul., Khabarovsk, 680022, Russian Federation

Author for correspondence.
Email: sa.alexeenko@gmail.com

MD, PhD, the Head of the Gastroenterological Department, Railroad Clinical Hospital at the Khabarovsk-1 station

Russian Federation

S. A. Alekseenko

Far Eastern State Medical University, 35 Murav’eva-Amurskogo ul., Khabarovsk, 680000, Russian Federation

Email: fake@neicon.ru
MD, PhD, Professor, the Head of the Hospital Therapy Chair, Far Eastern State Medical University Russian Federation

References

  1. Стяжкина СН, Журавлев КВ, Леднева АВ, Ларин ВВ, Климентов МН, Чернышева ТЕ. Роль коморбидной патологии в хирургии. Фундаментальные исследования. 2011;(7):138-40. (Styazhkina SN, Zhuravlev KV, Ledneva AV, Larin VV, Klimentov MN, Chernysheva TE. [Role of comorbid pathology in surgery]. Fundamental’nye issledovaniya. 2011;(7):138-40. Russian).
  2. Keohane J, Quigley EM. Functional dyspepsia and nonerosive reflux disease: clinical interactions and their implications. MedGenMed. 2007;9(3):31.
  3. De Bortoli N, Martinucci I, Bellini M, Savarino E, Savarino V, Blandizzi C, Marchi S. Overlap of functional heartburn and gastroesophageal reflux disease with irritable bowel syndrome. World J Gastroenterol. 2013;19(35):5787-97.
  4. Крапивная ОВ, Алексеенко СА. Опыт применения омепразола быстрого высвобождения при гастроэзофагеальной рефлюксной болезни с функциональной диспепсией и с синдромом раздраженного кишечника с запором. Клинические перспективы гастроэнтерологии, гепатологии. 2014;(2): 25-9. (Krapivnaya OV, Alekseenko SA. [Application of immediate-release omeprazole in the gastroesophageal reflux disease with functional dyspepsia and constipation predominant irritable bowel syndrome]. Klinicheskie perspektivy gastroenterologii, gepatologii. 2014;(2):25-9. Russian).
  5. Sifrim D, Zerbib F. Diagnosis and management of patients with reflux symptoms refractory to proton pump inhibitors. Gut. 2012;61(9):1340-54.
  6. Kaji M, Fujiwara Y, Shiba M, Kohata Y, Yamagami H, Tanigawa T, Watanabe K, Watanabe T, Tominaga K, Arakawa T. Prevalence of overlaps between GERD, FD and IBS and impact on health-related quality of life. J Gastroenterol Hepatol. 2010;25(6):1151-6.
  7. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130(5):1480-91.
  8. Алексеенко СА, Логинов АФ, Крапивная ОВ, Николаева АЕ. Соответствие Римских критериев II и III в диагностике функциональной диспепсии и сравнительная оценка эффективности ее лечения малыми дозами фамотидина. Клинические перспективы гастроэнтерологии, гепатологии. 2006;(5): 25-7. (Alekseenko SA, Loginov AF, Krapivnaya OV, Nikolaeva AE. [The Rome II and III criteria in diagnostic management of functional dyspepsia and comparative assessment of its treatment with low dose famotidin]. Klinicheskie perspektivy gastroenterologii, gepatologii. 2006;(5):25-7. Russian).
  9. Алексеенко СА. Алгоритмы диагностики и лечения гастроэзофагеальной рефлюксной болезни. Фарматека. 2006;(1): 48-9. (Alekseenko SA. [Algorithm for diagnosis and treatment of gastroesophageal reflux disease]. Farmateka. 2006;(1):48-9. Russian).
  10. Bennett EJ, Tennant CC, Piesse C, Badcock CA, Kellow JE. Level of chronic life stress predicts clinical outcome in irritable bowel syndrome. Gut. 1998;43(2):256-61.
  11. Yarandi SS, Nasseri-Moghaddam S, Mostajabi P, Malekzadeh R. Overlapping gastroesophageal reflux disease and irritable bowel syndrome: increased dysfunctional symptoms. World J Gastroenterol. 2010;16(10):1232-8.
  12. Frissora CL, Koch KL. The role of gender and biological sex in irritable bowel syndrome. Curr Gastroenterol Rep. 2005;7(4):257-63.
  13. Jung HK, Halder S, McNally M, Locke GR 3rd, Schleck CD, Zinsmeister AR, Talley NJ. Overlap of gastro-oesophageal reflux disease and irritable bowel syndrome: prevalence and risk factors in the general population. Aliment Pharmacol Ther. 2007;26(3):453-61.
  14. Tack J, Talley NJ, Camilleri M, Holtmann G, Hu P, Malagelada JR, Stanghellini V. Functional gastroduodenal disorders. Gastroenterology. 2006;130(5):1466-79.
  15. Bellini M, Gemignani A, Gambaccini D, Toti S, Menicucci D, Stasi C, Costa F, Mumolo MG, Ricchiuti A, Bedini R, de Bortoli N, Marchi S. Evaluation of latent links between irritable bowel syndrome and sleep quality. World J Gastroenterol. 2011;17(46): 5089-96.
  16. Fujiwara Y, Arakawa T, Fass R. Gastroesophageal reflux disease and sleep disturbances. J Gastroenterol. 2012;47(7):760-9.
  17. Xiao YL, Peng S, Tao J, Wang AJ, Lin JK, Hu PJ, Chen MH. Prevalence and symptom pattern of pathologic esophageal acid reflux in patients with functional dyspepsia based on the Rome III criteria. Am J Gastroenterol. 2010;105(12):2626-31.
  18. Mönnikes H, Heading RC, Schmitt H, Doerfler H. Influence of irritable bowel syndrome on treatment outcome in gastroesophageal reflux disease. World J Gastroenterol. 2011;17(27): 3235-41.
  19. Wu JC, Lai LH, Chow DK, Wong GL, Sung JJ, Chan FK. Concomitant irritable bowel syndrome is associated with failure of stepdown on-demand proton pump inhibitor treatment in patients with gastro-esophageal reflux disease. Neurogastroenterol Motil. 2011;23(2):155-60.
  20. Scarpellini E, Vos R, Blondeau K, Boecxstaens V, Farré R, Gasbarrini A, Tack J. The effects of itopride on oesophageal motility and lower oesophageal sphincter function in man. Aliment Pharmacol Ther. 2011;33(1):99-105.
  21. Ивашкин ВТ, Шептулин АА, Трухманов АС. Клинические аспекты функциональной диспепсии и эффективность ганатона (итоприда гидрохлорида) в ее лечении. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2009;(6):17-22. (Ivashkin VT, Sheptulin AA, Trukhmanov AS. [Clinical aspects of functional dyspepsia and efficacy of ganaton (itopride hydrochloride]. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii. 2009;(6): 17-22. Russian).

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2014 Krapivnaya O.V., Alekseenko S.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies