Women with GERD can make do with lower PPI doses
Female patients taking long-term proton pump inhibitors (PPIs) have threefold odds of tolerating half of their prior dose, suggesting that the female gender is associated with an increased probability for successful step-down, according to a recent study.
A double-blind randomized trial was conducted to determine the proportion of patients with gastro-oesophageal reflux disease (GERD) on PPI therapy who could reduce their prior dosage by half and to identify predictors of successful step-down.
Researchers randomly assigned a total of 100 patients with endoscopically verified erosive oesophagitis on long-term PPI therapy to either step down their dose by half (n=51; 25 females) or continue with the same dose for 8 weeks (n=49; 24 females). Fasting gastrin levels were measured before and after treatment. Successful step-down throughout the study period was the primary endpoint.
Female patients, compared with male patients, had higher gastrin levels (78 vs 50 pg/mL; p=0.007). Among the participants assigned to the step-down intervention, only 3/25 (12 percent) women did not complete the 2 months of lower-dose therapy vs 9/25 (36 percent) men (p=0.09).
The strongest predictor for successful step-down was female gender (odds ratio, 1.27; 95 percent CI, 1.01 to 1.60). The reduction group had a twofold chance of failure in maintaining symptom control as compared with the control group (24 vs 13 percent; p=0.2).
“These results indicate that women with gastro-oesophageal reflux disease might manage with lower doses of PPIs as compared with men,” researchers said.
Gastric acid inhibition leads to appropriate hypergastrinemia, and a gender difference has been shown in fasting gastrin, with greater levels observed among women than men on long-term PPI therapy, according to researchers.