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

• Published in: Gut Vol. 61; no. 4; pp. 501 - 506
• Main Authors: Zerbib, Frank, Belhocine, Kafia, Simon, Mireille, Capdepont, Maylis, Mion, François, des Varannes, Stanislas Bruley, Galmiche, Jean-Paul
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.04.2012; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: 13C-urea breath test; achalasia; Acids; Adult; Aged; Aged, 80 and over; anal incontinence; anorectal physiology; anti-reflux therapy; Anxiety; Biological and medical sciences; Body Mass Index; Catheters; Dyspepsia - etiology; endoscopic procedures; Endoscopy; Esophageal pH Monitoring; Esophagitis, Peptic - etiology; Esophagoscopy; Esophagus; Female; functional digestive disorders; gastric diseases; gastric inflammation; gastric physiology; gastro-oesophageal junction; Gastro-oesophageal reflux; gastroduodenal motility; Gastroenterology. Liver. Pancreas. Abdomen; Gastroesophageal reflux; Gastroesophageal Reflux - complications; Gastroesophageal Reflux - drug therapy; Gastroesophageal Reflux - physiopathology; gastroesophageal reflux disease; gastroparesis; Humans; Irritable bowel syndrome; Irritable Bowel Syndrome - complications; liver function test; lower oesophageal sphincter; Male; manometry; Medical sciences; Middle Aged; oesophageal impedance; oesophageal motility; Other diseases. Semiology; Prognosis; proton pump inhibitors; Proton Pump Inhibitors - therapeutic use; Questionnaires; short chain fatty acids; Studies; Treatment Failure; Treatment Outcome; Young Adult; Gastroesophageal reflux; Esophageal disease; Gastroenterology; pH; Digestive diseases; Predictive factor; Impedance; Proton pump inhibitor; Esophagus
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2011-300798

ObjectiveApproximately 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.DesignPatients 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).ResultsOne 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/m2 (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/m2 (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/m2 (p=0.029).ConclusionNo 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/m2 are strongly associated with PPI failure.