Esomeprazole 40 mg once a day in patients with functional dyspepsia: the randomized, placebo-controlled "ENTER" trial.

Abstract

OBJECTIVE:

The etiologies of functional dyspepsia (FD) are unclear, but in some studies, treatment with a proton pump inhibitor has been beneficial. The objective of this study was to evaluate the efficacy of esomeprazole 40 mg once a day compared to placebo in achieving symptom relief in primary care patients with FD.

METHODS:

This was a randomized, placebo-controlled trial in adult FD patients, who had at least moderate severity of symptoms, defined as a score of > or =4 on a 7-point Global Overall Symptom (GOS) scale. Patients were excluded if they had predominant symptoms of heartburn or regurgitation; after a normal baseline endoscopy, patients were randomized to esomeprazole 40 mg once daily or placebo for 8 wk. The primary outcome measure was symptom relief (GOS < or =2) at 8 wk.

RESULTS:

Of the 502 enrolled patients, 224 were randomized. The main reasons for exclusion were abnormal endoscopic findings, especially esophagitis. A significantly greater proportion of patients in the esomeprazole group achieved symptom relief at 4 but not at 8 wk compared to placebo: 4 wk esomeprazole 50.5% versus placebo 32.2%, p= 0.009; 8 wk esomeprazole 55.1% versus placebo 46.1%, p= 0.16. A similar relationship at 4 and 8 wk was seen for symptom resolution (GOS = 1) and improvement (DeltaGOS > or =2).

CONCLUSION:

For the primary outcome measure of symptom relief at 8 wk, there was no statistically significant difference between esomeprazole 40 mg once a day and placebo. However, at 4 wk, esomeprazole was significantly more effective than placebo for symptom relief. The difference in therapeutic gain between 4 and 8 wk was largely due to a higher placebo response rate at 8 wk.

• Authors: Sander Veldhuyzen van Zanten, David Armstrong, Naoki Chiba, Nigel Flook, Robert J White, Bijan Chakraborty, Ally Gasco
• Journal: The American journal of gastroenterology (Am J Gastroenterol) Vol. 101 Issue 9 Pg. 2096-106 (Sep 2006) ISSN: 0002-9270 [Print] United States
• PMID: 16817845 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Ulcer Agents
• Esomeprazole

Topics

• Administration, Oral
• Adult
• Aged
• Anti-Ulcer Agents (administration & dosage, therapeutic use)
• Dose-Response Relationship, Drug
• Double-Blind Method
• Dyspepsia (diagnosis, drug therapy)
• Endoscopy, Gastrointestinal
• Esomeprazole (administration & dosage, therapeutic use)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Quality of Life
• Severity of Illness Index
• Treatment Outcome