Previous studies have shown that patients with gastroesophageal reflux disease (GERD) have slower rates of gastric emptying than controls. However, the involvement of delayed gastric emptying (DGE) in the pathophysiology of gastro-esophageal reflux disease (GERD) remains debatable. The aim of this study was to investigate if treatment with prokinetics in addition to proton pump inhibitor (PPI) therapy improves clinical symptoms in dyspeptic GERD patients with or without DGE.

Thirty consecutive patients refractory to PPI over a six-month period were included in the study. Gastric emptying scintigraphy was employed to determine DGE, which was designated when gastric emptying time (T1/2) was >70 min. Patients were divided according to the presence of dyspepsia into the dyspeptic group (n=12) and non-dyspeptic group (n=18). In addition to esomeprazole (40 mg), mosapride citrate was administered to patients for 4 weeks. Symptoms were evaluated using a standardized questionnaire before and after treatment.

There was no statistical difference in age and sex between the dyspeptic group and the non-dyspeptic group (P=0.92 and P=0.23, respectively). Prevalence of esophagitis was similar between the dyspeptic and non-dyspeptic groups (58% vs 39%, P=0.31). DEG was detected in 75% of subjects in the dyspeptic group; while 28% subjects in the non-dyspeptic group (P=0.01) displayed DEG. Improvement in symptoms was greater in the dyspeptic group than that in the non-dyspeptic group (75% vs 33%, P=0.02).

Gastric emptying in dyspeptic patients with GERD is significantly slower than in non-dyspeptic patients regardless of esophagitis. Combination therapy with prokinetics in addition to PPI improves typical GERD symptoms in dyspeptic patients with GERD.