Gastro-oesophageal reflux disease (GERD) is known as esophageal mucosal injury or regurgitation of stomach contents. Acid reducing agents, particularly proton pump inhibitors (PPI), are effective in the management of GERD. However, about 20-30 % of affected cases do not respond to these agents. Therefore, other drugs that could affect the lower esophageal sphincter pressure or diminish its transient relaxations are possible choices. It is presumed that midodrine, an alpha agonist drug, may be effective in treating refractory patients according to above mentioned mechanisms. In this clinical trial, midodrine would be compared with placebo.
Sixty patients between 18 to 65 ages who have already experienced at least one of the symptoms of heartburn or regurgitation despite one month consumption of
High-dose PPIs will be included. Those with history of gastrointestinal surgery, concomitant diseases, use of certain medications, dysphagia and pregnancy are excluded from the study. Upper endoscopy with biopsy will be performed first. Then, randomly, cases are placed into 3 groups, one as placebo and two others taking two different dosages of midodrine for one month. As the primary outcome, patients are asked to score the intensity of their symptoms, based on a 0-10 visual scale, at the beginning of the study and then weekly up to 2 weeks after drug cessation. Previously validated Gastro esophageal reflux quality of life questionnaire will be filled out by the attendant manager biweekly. Finally, statistical analysis will be conducted.