Positive predictors for gastroesophageal reflux disease and the therapeutic response to proton-pump inhibitors

World J Gastroenterol. 2014 Apr 14;20(14):4017-24. doi: 10.3748/wjg.v20.i14.4017.

Abstract

Aim: To identify objective and subjective predictors for the reliable diagnosis of gastroesophageal reflux disease (GERD) and the response to proton pump inhibitor (PPI) therapy.

Methods: Retrospectively, 683 consecutive patients suspected for GERD who underwent pH-metry/impedance measurement (pH/MII) were analyzed. All patients had previously undergone standard PPI treatment (e.g., pantoprazole 40 mg/d or comparable). Four hundred sixty patients were at least 10 d off PPIs (group A), whereas 223 patients were analyzed during their ongoing PPI therapy (group B). In addition, all patients completed a standardized symptom- and lifestyle-based questionnaire, including the therapeutic response to previous PPI trials on a 10-point scale. Uni- and multivariance analyses were performed to identify criteria associated with positive therapeutic response to PPIs.

Results: In group A, positive predictors (PPs) for response in empirical PPI trials were typical GERD symptoms (heartburn and regurgitation), a positive symptom index (SI) and pathological results in pH/MII, along with atypical symptoms, including hoarseness and fullness. In group B, regular alcohol consumption was associated with the therapeutic response. The PPs for pathological results in pH/MII in group A included positive SI, male gender, obesity, heartburn and regurgitation. In group B, the PPs were positive SI and vomiting. Analyzing for positive SI, the PPs were pathological pH and/or MII, heartburn regurgitation, fullness, nausea and vomiting in group A and pathological pH and/or MII in group B.

Conclusion: Anamnestic parameters (gender, obesity, alcohol) can predict PPI responses. In non-obese, female patients with non-typical reflux symptoms, pH/MII should be considered instead of empirical PPIs.

Keywords: Follow-up; Gastroesophageal reflux; Gastroesophageal reflux disease; Impedance pH measurement; Non-erosive reflux disease; Proton pump inhibitor; Therapy.

MeSH terms

  • 2-Pyridinylmethylsulfinylbenzimidazoles / therapeutic use
  • Adult
  • Aged
  • Electric Impedance
  • Esophageal pH Monitoring
  • Female
  • Gastroesophageal Reflux / diagnosis*
  • Gastroesophageal Reflux / drug therapy*
  • Heartburn
  • Humans
  • Hydrogen-Ion Concentration
  • Life Style
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pantoprazole
  • Predictive Value of Tests
  • Proton Pump Inhibitors / therapeutic use*
  • ROC Curve
  • Retrospective Studies
  • Surveys and Questionnaires
  • Treatment Outcome

Substances

  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Proton Pump Inhibitors
  • Pantoprazole