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Voltaren reduces acid-induced heartburn symptoms
Premedication with the NSAID Voltaren reduced heartburn symptoms induced by acid perfusion in healthy volunteers, according to results from a Japanese study.
The primary aims of the study were to determine whether Voltaren (diclofenac, Novartis) improved acid-induced heartburn in healthy individuals by inhibiting the overproduction of prostaglandin E2 (PGE2) in the esophagus, and to identify correlations between esophageal PGE2 levels and heartburn symptoms.
Researchers performed a prospective, double-blind, placebo-controlled, two-period, cross-over study involving 12 healthy male volunteers over three visits. Participants were randomly assigned to receive 37.5 mg diclofenac at visit two then placebo at visit three, or placebo at visit two then diclofenac at visit three, separated by a 2-week washout period.
Diclofenac or placebo were given at 6 hours and 2 hours before acid perfusion of the lower esophagus (0.15 mol/L for 30 minutes), and endoscopic biopsies were performed before and after the acid perfusion test. Daily upper abdominal symptoms were reported with a validated questionnaire, and upper GI symptom severity during acid perfusion was assessed using the acid perfusion sensitivity score (APSS). PGE2 levels were measured in the biopsy samples using an enzyme-linked immunosorbent assay.
Diclofenac significantly reduced the APSS for heartburn (47.5 ± 8.9) compared with placebo (82.2 ± 12.2; P < .01), but did not significantly reduce the APSS for any other upper GI symptoms. Diclofenac also reduced esophageal PGE2 overproduction after acid perfusion (11.4 ± 3.5 pg/mg protein) compared with placebo (23.3 ± 5.2 pg/mg protein; P < .05), and there was a correlation between APSS for heartburn and esophageal PGE2 levels (r = 0.53; P < .05). No adverse events occurred.
“In conclusion, this study showed that diclofenac attenuated acid-induced esophageal sensation through the inhibition of esophageal PGE2 overproduction,” the researchers wrote. “Esophageal PGE2 may play a significant role in heartburn symptom generation, and control of PGE2 may offer a new therapeutic target for heartburn management.” – by Adam Leitenberger
Disclosure: One of the researchers reports he is an employee of Ono Pharmaceuticals. All other researchers report no relevant financial disclosures.