GASTROESOPHAGEAL REFLUX DISEASE IN INTELLECTUALLY DISABLED INDIVIDUALS - LEADS FOR DIAGNOSIS AND THE EFFECT OF OMEPRAZOLE THERAPY

Objectives: The therapeutic approach to gastroesophageal reflux diseas e (GERD) in intellectually disabled individuals has not been studied e xtensively. So far, only low response rates to medical and surgical th erapy of GERD have been reported. However, the efficacy of proton pump inhibitors, to date the most effective medical therapy for GERD, has never been evaluated in this population. Our purpose, therefore, was t o study the effect of omeprazole on healing and symptom relief in the intellectually disabled. Methods: The treatment scheme was as follows: omeprazole 40 mg was given once daily (o.d.) as a healing dose for 3 months, and omeprazole 20 mg o.d. was given as a maintenance dose for another 3 months, to intellectually disabled subjects viith endoscopic ally proven esophagitis, grades I-IV, according to Savary-Miller class ification. After 3 and 6 months, the result of this treatment was eval uated by symptom scoring and/or endoscopy. In case of relapse, the dos e was increased. Results: At the first endoscopy, 40 of 107 patients ( 37 %) had grade I, 36 (34%) grade II, 18 (17 %) grade III, and 13 (12% ) grade IV esophagitis. In 92 of 104 patients (88%), the treatment sch eme was effective in healing the esophagitis and keeping patients in r emission, independent of the severity of esophagitis. In 11 of 104 (11 %) patients, a symptomatic relapse was observed after the dose was dec reased to 20 mg o.d. However, all of these patients became symptom fre e again after the dose was increased to 40 mg o.d., and all were heale d endoscopically at the end of the study. One (1%) patient needed omep razole 60 mg o.d. for healing, but in this patient, no relapse was see n while on a maintenance dose of omeprazole 40 mg o.d. Marked improvem ent of persistent vomiting, hematemesis, regurgitation, food refusal, iron deficiency anemia, and depressive symptoms was seen at the end of the study. Conclusions: This study indicates that omeprazole is highl y effective for all grades of esophagitis in the intellectually disabl ed. The dose needed to maintain them in remission can be titrated acco rding to the reflux symptoms.