Double-dose Rabeprazole Accelerates and Sustains the Control of Symptoms in Patients With NERD

Overview

To the best of our knowledge, there has been no randomized controlled trial to compare double dose PPI therapy with standard one dose PPI therapy for NERD patients. Thus, we hypothesize that a double dose PPI would accelerate and sustain the control of symptom in NERD patients.

Full Title of Study: “Double-dose Rabeprazole Accelerates and Sustains the Control of Symptoms in Patients With NERD: a Randomized Controlled Trial”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: October 2012

Detailed Description

In Asian, the majority of GERD cases are cases of nonerosive reflux esophagitis(NERD). NERD is a difficult -to-treat acid reflux condition even with PPI compared to reflux esophagitis(RE). In addition, the quality of life of NERD patients is quite low, NERD patients need quicker and more effective treatment options. At present, PPI-based step-down treatment is recommended for GERD patients. Doubling th PPI dose has become a commonly practiced therapeutic strategy in patients with GERD who failed PPI once daily. In patients with symptomatic GERD who failed the one dose PPI can increase the rate of overall symptom improvement by 22-26%. There are various mechanisms for standard dose PPI failure in GERD patients. Esophageal hypersensitivity is likely the underlying mechanism in a significant number of patients. Patients with the sensitive esophagus (normal endoscopy and pH test but positive symptom index) were more likely to respond to PPI twice a day. It is thus of clinical interest to determine whether an increased dosage of PPI can achieve rapidly the control of symptoms for patient with NERD patients.

Interventions

  • Drug: rabeprazole
    • rabeprazole 20mg bid per day for 2 weeks
  • Drug: standard dose rabeprazole
    • rabeprazole 20mg qd per day for 2 weeks

Arms, Groups and Cohorts

  • Active Comparator: Double dose rabeprazole
    • Rabeprazole 20m bid per day will be given for 2 weeks
  • Placebo Comparator: standard dose rabeprazole
    • rabeprazole 20mg per day will bi given for 2 weeks

Clinical Trial Outcome Measures

Primary Measures

  • symptom improvement at 2 week after double dose rabeprazole treatment
    • Time Frame: Two weeks
    • symptom improvement according to FSSG(the frequency scale for the symptoms of GERD) at 2 week after double dose rabeprazole treatment

Secondary Measures

  • sustained symptom improvement at 6 week after treatment
    • Time Frame: 6 weeks
    • sustained symptom improvement assessed by FSSG(the frequency scale for the symptoms of GERD)score at 6 week after treatment

Participating in This Clinical Trial

Inclusion Criteria

  • heartburn and/or reflux at least twice weekly in the absence of visible esophageal mucosal breaks at endoscopy Exclusion Criteria:

  • pregnancy – lactation – Hx of gastric surgery – Hx of gastric cancer or peptic ulcer – major medical problems (including CHF, renal failure, COPD, asthma, liver cirrhosis) – severe systemic illness – Hx of malignancy, allergy Hx to rabeprazole – patients who had taken antibiotics – antisecretory agents including H2-blocker – PPI within 4 weeks before endoscopy – current usage of steroids, NSAIDs, aspirin, anticoagulant medication

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Inje University
  • Provider of Information About this Clinical Study
    • Principal Investigator: Eun Hee Seo, Fellow – Inje University
  • Overall Official(s)
    • Tae Oh Kim, M.D. PhD., Study Director, Internal Medicine, Haeundae Paik Hospital
    • Eun Hee Seo, M.D, Principal Investigator, Internal Medicine, Haeundae Paik Hospital

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