Adding Dopamine Antagonist to PPI Therapy for GERD

Adding domperidone to proton pump inhibitor (PPI) therapy was generally safe and effective for treating gastroesophageal reflux disease (GERD) in children and adults, according to a systematic review and meta-analysis published in the Journal of Clinical Medicine.

“Although PPIs are first-line medications for GERD, up to one-third of patients do not experience symptom relief after an 8-week course of PPI therapy, and up to 40% of patients with nonerosive reflux disease do not respond to PPI therapy once daily in terms of symptom relief,” explained a research team from Malaysia.

The systematic review and meta-analysis included 11 randomized controlled trials that investigated the benefits of adding domperidone to PPI therapy for GERD. Domperidone, an antiemetic agent, is a dopaminergic blocker that increases lower esophageal sphincter pressure and activates gastric motility. The meta-analysis spanned a total 841 patients, 419 in the PPI plus domperidone group and 422 in the PPI monotherapy group. Participant ages ranged from 2 through 55 years.

PPI plus domperidone significantly reduced global GERD symptoms, according to the study.

Specifically, combined therapy provided greater symptom relief in trials that used the Frequency Scale for the Symptoms of GERD and the Gastroesophageal Reflux Disease Questionnaire, researchers reported. Results also favored combination therapy over PPI monotherapy for improved heartburn, reflux frequency, and duration of acid exposure time.

The analysis found no statistically significant increases in adverse events with combined therapy compared with PPI monotherapy.

“We demonstrated in this systematic review and meta-analysis that the combination of domperidone and PPI therapy was more effective than PPIs alone in treating GERD,” researchers wrote.

Reference:
Zamani NF, Sjahid AS, Tuan Kamauzaman TH, Lee YY, Islam MA. Efficacy and safety of domperidone in combination with proton pump inhibitors in gastroesophageal reflux disease: a systematic review and meta-analysis of randomised controlled trials. J Clin Med. 2022;11(18):5268. doi:10.3390/jcm11185268