Goodnight GORD! - Getting a better night's sleep with GORD

Gastro-oesophageal reflux disease, or GORD, is one of the most common diseases affecting the adult population, especially the elderly. Up until now, it as been hard to gauge the effectiveness of treatment from the perspective of the patient. This area has been under investigation and a recently published paper in the Journal of Clinical Drug Investigation has compared two leading proton pump inhibitors (PPIs) using a newly devised questionnaire aimed at understanding their effectiveness, and whether complete remission of GORD is achievable.

Using the comprehensive ReQuest questionnaire, two popular PPIs were assessed on many factors including relief of symptoms, effect on night-time symptoms as well as immediacy of effect. In most of the fields compared, pantoprazole (Somac) was found to be at least equally effective, if not more so (in the area of night time symptoms) and therefore should be considered as first line therapy for sufferers of GORD, and the more serious progressive diseases such as erosive GORD and erosive oesophagitis.

Gastroesophageal reflux disease (GORD) is a chronic disease that commonly progresses to a range of potentially serious oesophageal complications from oesophageal ulcers through to oesophageal cancer. It is characterized by reflux of the stomach contents into the oesophagus, oropharynx, larynx, or airway and is associated with heartburn, acid regurgitation, and indigestion. Gastroesophageal reflux disease is one of the most common chronic gastrointestinal disorders. It has been reported that GORD affects up to one-third of adults.

Adequate treatment of this disease and its complications should either prevent repeated reflux of gastric contents into the oesophagus or reduce the damaging effect of gastric acid. As no pharmaceutical agent can fully correct the motor dysfunction responsible for acid reflux into the oesophagus, acid suppression remains the most effective way to relieve symptoms and to promote healing of oesophagitis in patients with GORD.

Gastro-oesophageal reflux disease (GORD) is associated with varying symptoms, from simple heartburn to coughing to back pain. Symptoms are troublesome for patients and at times, can impact on their lifestyles and rest.

Most troubling for many people revolve around the how the GORD symptoms affect them at night. GORD can cause sufferers to be woken from sleep with feelings of pain, nausea, indigestion or a constant cough. The discomfort caused can severely disrupt sleep for many, and this can result in day-time suffering for the GORD patient. Therefore, any medication that can decrease these symptoms are favoured in treatment.

Assessment of symptoms using developed scales have been employed to assess response to treatment in GORD, and recently a new scale, The ReQuest^TM questionnaire, allows patients to self-report changes on a broad range of GORD-related symptoms on a daily basis.

Two popular PPIs currently available for the first line treatment of GORD are the first two medications that have been comprehensively surveyed using the new ReQuest questionnaire assessment tool.

The initial effects of pantoprazole (Somac) have also been investigated with regard to the intensity and frequency of acid episodes. Early findings from a large field trial of pantoprazole (Somac) 40mg once daily for 4 weeks showed that this PPI significantly improved GORD-associated symptoms from day 2 onwards. Patients who were treated with a 4 week course of pantoprazole (Somac) reported less symptoms and relapses after treatment than if they had not been treated. This suggests that pantoprazole (Somac) may be particularly suitable for on-demand treatment for GORD.

In patients with more severe disease, such as erosive oesophagitis, pantoprazole (Somac) was reported to be also very effective at decreasing the intensity of symptoms such as heartburn, and especially heartburn that occurs at night which sleep disturbances. Therefore these studies have shown that patients who received treatment with a popular PPI, pantoprazole (Somac) 20 mg/day, had initial and sustained symptom relief.

Bearing in mind this information, it is recommended you discuss your treatment options in detail with your treating doctor and whether the above medications are suited to you.

Reference:

Thomson ABR. The concept of complete remission of gastro-oesophageal reflux disease comparative efficacy of pantoprazole and esomeprazole using the ReQuest^TM questionnaire, Clin Drug Invest 2007; 27(10): 663-672.