Changes in esophageal functional state during combined acid-suppressive and epithelial protective therapy in patients with non-erosive reflux disease

Objective. To evaluate the effect of combination therapy with rebamipide and proton pump inhibitor (PPI) on the functional state of the esophagus in patients with non-erosive reflux disease (NERD). Patients and methods. The study included 60 patients, 39 of whom had a confirmed diagnosis of NERD and were randomized into two groups: the study group receiving combination therapy with rebamipide (300 mg/day) and omeprazole (20 mg/day), and the comparison group receiving omeprazole monotherapy (20 mg/day). The study also included 13 patients with functional heartburn and 8 patients with esophageal hypersensitivity, who were divided into two groups. The duration of treatment was four weeks. To assess the functional state of the esophagus and gastroesophageal junction, as well as the esophageal mucosal resistance, the values of esophageal 24-hour pH-impedance testing and high-resolution manometry before and after treatment were analyzed. Results. In patients with NERD receiving combination therapy, the percentage of time with pH <4 was statistically significantly lower in the follow-up examination after the end of treatment and withdrawal of medications compared to the period before treatment (p = 0.048). In patients receiving PPI monotherapy, no statistically significant changes in the percentage of time with pH <4 were found in the dynamics (p = 0.465). There were statistically significant differences in lower esophageal sphincter pressure between two groups after treatment (p = 0.017). However, analyzing this parameter within each group before and after treatment revealed no statistically significant changes in lower esophageal sphincter pressure. In patients with esophageal hypersensitivity and functional heartburn, changes in the values of esophageal 24-hour pH-impedance testing and highresolution manometry before and after treatment did not reach statistical significance in any of the examined groups. Conclusion. The use of combination therapy with PPI and rebamipide is a safe and effective method to achieve adequate acid suppression, including in the post-treatment period. This therapeutic approach may improve esophageal motility and the state of lower esophageal sphincter. Key words: proton pump inhibitors, non-erosive reflux disease, epithelial protective therapy