Heartburn Meds for Any Size

GERD and erosive esophagitis symptoms improve with PPIs regardless of BMI

(RxWiki News) Heavier set individuals are more likely to have acid reflux. But it is unclear whether reflux medicines are enough to stop heartburn and other symptoms in the overweight and obese.

A new study showed that certain prescription acid reflux medicines decreased heartburn regardless of patients' weight.

Researchers said that patients with a greater body mass index (BMI) can especially find therapeutic relief from heartburn with a proton pump inhibitor medicine, which limits stomach acid production, when taken once per day as prescribed.

"Talk to a gastroenterologist about heartburn meds."

Non-erosive reflux disease (NERD) is linked to increasing BMI – a ratio of a person's height to weight. In the condition, stomach acid seeps up into the esophagus between the mouth and stomach without damaging the connecting tube.

David Peura, MD, professor emeritus of internal medicine in the Division of Gastroenterology and Hepatology at the University of Virginia Health System, led researchers in investigating whether a person's BMI impacts heartburn symptoms.

They also aimed to see how well patients responded to prescription medications that treat NERD and erosive esophagitis (EE), which is an acid reflux condition that damages the esophagus.

The study included 621 patients with NERD and more than 2,600 patients with EE.

Half the NERD patients received 30 milligrams of the medication dexlansoprazole MR (Dexilant, Kapidex) once daily for one month. The other half of the patients received a placebo, or fake medication.

At the same time, the erosive esophagitis patients received either 60 milligrams of dexlansoprazole MR or 30 milligrams of lansoprazole (Prevacid) once per day for two months.

The medicines fall under a class of medications called proton pump inhibitors (PPIs), which inhibit the production of stomach acid.

Participants kept track of their symptoms in a daily diary. They noted the frequency and severity of their symptoms.

The impact of PPIs on reducing heartburn severity and frequency was similar across BMI categories in both groups of patients, researchers found. Prior to taking PPIs, heartburn symptoms were more intense as the patient's BMI went up.

Researchers also found that obese patients with a BMI greater than 30 who took dexlansoprazole for their erosive esophagitis, but not lansoprazole, healed faster than non-obese patients.

"Since patients with higher BMI have greater baseline symptom severity and frequency, and more severe grades of EE, they may actually derive greater therapeutic benefit from dexlansoprazole MR treatment than leaner patients," researchers wrote in their report.

"Additional prospective studies designed to assess the impact of increasing BMI on therapeutic response to PPI therapy in both NERD and EE patients are needed to confirm these results," they wrote.

The authors noted a few limitations to the study, including that it was not designed to see how BMI impacted the effectiveness of PPI medications. The researchers also did not look at the impact of other kinds of PPI medications. Furthermore, heartburn was not an inclusion criterion in the study.

The study was published in the April issue of Alimentary Pharmacology & Therapeutics.

The authors served as consultants and are employed by a few pharmaceutical companies, including AstraZeneca, Novartis Consumer Products, Takeda Pharmaceuticals and Takeda Global Research & Development Center.

Funding was provided by the Takeda Global Research & Development Center and the Takeda Pharmaceuticals, Inc.

Review Date: 
March 26, 2013