How to achieve a long-term remission in patients with chronic gastrointestinal diseases?

The article presents the main aspects of pharmacotherapy of patients with chronic gastrointestinal (GI) diseases. The overall goal of our research was to confirm the current paradigm, under which the remission of diseases is achieved by using pharmacotherapy and maintained with minimum doses of drugs. The achievement of this goal is considered on the example of gastroesophageal reflux disease (GERD). A total of 140 patients were randomly selected and divided into three groups: Group 1 (60 patients with acid-dependent variant (ADV) of the disease) received PPIs at medium therapeutic doses for 8 weeks. It took on average 4 weeks of treatment to relieve clinical symptoms and 8 weeks of treatment to reverse morpho-endoscopic lesions on the esophageal mucosa. During the 36-week follow-up period without maintenance therapy, 5 patients (8.3%) remained in remission, while 55 patients (91.7%) had clinical and morphological exacerbations. Group 2 (60 patients with acid-independent variant (AIV)) received rebamipide (Rebagit) at a daily dose of 300 mg for 8 weeks. It took on average 4 weeks to relieve clinical symptoms and 8 weeks to reverse morpho-endoscopic lesions on the esophageal mucosa. During the 48-week follow-up period without maintenance therapy, 6 patients (10%) remained in remission, while 90% of patients had exacerbations. Without pharmacological support, exacerbation was observed in the majority of patients (91.7%) within 48 weeks. Therefore, the prescription of maintenance therapy was required. In Group 3, 10 patients with ADV received omeprazole at a dose of 10 mg per day for 8 weeks after completing the main therapy course; 10 patients with AIV received rebamipide at a dose of 100 mg per day within the same period. During the long-term (48 weeks) follow-up period, the disease exacerbation was identified only in a third of patients with both ADV and AID GERD, and it only manifested as clinical symptoms of the disease without morpho-endoscopic lesions on the esophageal mucosa. Most patients remained in stable remission.