Clinical, but not oesophageal pH-impedance, profiles predict response to proton pump inhibitors in gastro-oesophageal reflux disease.

Abstract

OBJECTIVE:

Approximately 30% of patients with gastro-oesophageal reflux disease (GORD) do not achieve adequate symptom control with proton pump inhibitors (PPIs). The aim of this study was to determine whether any symptom profile or reflux pattern was associated with refractoriness to PPI therapy.

DESIGN:

Patients with typical GORD symptoms (heartburn and/or regurgitation) were included and had 24 h pH-impedance monitoring off therapy. Patients were considered to be responders if they had fewer than 2 days of mild symptoms per week while receiving a standard or double dose of PPI treatment for at least 4 weeks. Both clinical and reflux parameters were taken into account for multivariate analysis (logistic regression).

RESULTS:

One hundred patients were included (median age 50 years, 42 male), 43 responders and 57 non-responders. Overall, multivariate analysis showed that the factors associated with the absence of response were absence of oesophagitis (p=0.050), body mass index (BMI) ≤25 kg/m(2) (p=0.002) and functional dyspepsia (FD) (p=0.001). In patients who reported symptoms during the recording (n=85), the factors associated with PPI failure were BMI ≤25 kg/m(2) (p=0.004), FD (p=0.009) and irritable bowel syndrome (p=0.045). In patients with documented GORD (n=67), the factors associated with PPI failure were absence of oesophagitis (p=0.040), FD (p=0.003), irritable bowel syndrome (p=0.012) and BMI ≤25 kg/m(2) (p=0.029).

CONCLUSION:

No reflux pattern demonstrated by 24 h pH-impedance monitoring is associated with response to PPIs in patients with GORD symptoms. In contrast, absence of oesophagitis, presence of functional digestive disorders and BMI ≤25 kg/m(2) are strongly associated with PPI failure.

• Authors: Frank Zerbib, Kafia Belhocine, Mireille Simon, Maylis Capdepont, François Mion, Stanislas Bruley des Varannes, Jean-Paul Galmiche
• Journal: Gut (Gut) Vol. 61 Issue 4 Pg. 501-6 (Apr 2012) ISSN: 1468-3288 [Electronic] England
• PMID: 21997546 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Proton Pump Inhibitors

Topics

• Adult
• Aged
• Aged, 80 and over
• Body Mass Index
• Dyspepsia (etiology)
• Esophageal pH Monitoring
• Esophagitis, Peptic (etiology)
• Esophagoscopy
• Female
• Gastroesophageal Reflux (complications, drug therapy, physiopathology)
• Humans
• Irritable Bowel Syndrome (complications)
• Male
• Middle Aged
• Prognosis
• Proton Pump Inhibitors (therapeutic use)
• Treatment Failure
• Treatment Outcome
• Young Adult