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GERD assessment including pH metry predicts a high response rate to PPI standard therapy.

ABSTRACT: BACKGROUND: Inadequate response to proton pump inhibitor (PPI) therapy in patients with gastroesophageal reflux disease (GERD) is reported in up to 40%. Patients with non erosive reflux disease (NERD) have lower response rates compared to patients with erosive reflux disease (ERD); pH metry contributes to GERD diagnosis and is critical for proper diagnosis of NERD. Aim of the study was to assess the need for doubling esomeprazole standard dose (40?mg) for 4?weeks in PPI naive patients with typical reflux symptoms and diagnosis of GERD based on endoscopy and 48?hours, wireless pH metry. METHODS: All patients underwent upper GI endoscopy. Symptoms were recorded with a structured questionnaire (RDQ) and acid exposure was determined by 48?hours, wireless pH monitoring (BRAVO). In case of abnormal acid exposure, patients received a short term treatment with esomeprazole 40?mg q.d. for 4?weeks. If symptoms persisted, patients underwent a second pH metry on PPI and the dose was increased to 40?mg b.i.d. RESULTS: 31 consecutive patients with typical reflux symptoms underwent 48?hours pH monitoring. 22 patients (71%) had abnormal acid exposure, 9 patients had normal pH metry (29%). Of the 9 patients with normal pH metry, 2 were found with erosive esophagitis and 7 without endoscopic abnormalities. 24 patients with documented GERD received esomeprazole treatment. 21 patients achieved complete symptom resolution with 40?mg q.d. after 4?weeks (88%). Only 2 patients required doubling the dose of esomeprazole for complete symptom resolution, 1 patient remained with symptoms. CONCLUSIONS: Patients with typical reflux symptoms and abnormal acid exposure have a high response rate to standard dose esomeprazole regardless of whether they have ERD or NERD.

SUBMITTER: Kandulski A

PROVIDER: S-EPMC3562521 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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GERD assessment including pH metry predicts a high response rate to PPI standard therapy.

Kandulski Arne A Peitz Ulrich U Mönkemüller Klaus K Neumann Helmut H Weigt Jochen J Malfertheiner Peter P

BMC gastroenterology 20130116

<h4>Background</h4>Inadequate response to proton pump inhibitor (PPI) therapy in patients with gastroesophageal reflux disease (GERD) is reported in up to 40%. Patients with non erosive reflux disease (NERD) have lower response rates compared to patients with erosive reflux disease (ERD); pH metry contributes to GERD diagnosis and is critical for proper diagnosis of NERD. Aim of the study was to assess the need for doubling esomeprazole standard dose (40 mg) for 4 weeks in PPI naive patients wit ...[more]

PMID: 23324360

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Project description:BACKGROUND:Increasing prevalence of obesity has shown an associated increase in gastroesophageal reflux disease (GERD)-related diseases. Proton pump inhibitor (PPI) therapy has been demonstrated to reduce the incidence of such diseases. The study's aim was to analyze the Clinical Practice Research Datalink (CPRD) to determine factors that increase the propensity of obese patients on PPIs to develop Barrett's esophagus (BE) and esophageal carcinoma. METHOD:A case-control population study was carried out, including patients from the CPRD. Clinicopathological factors were extracted for each patient alongside clinical endpoints of GERD, BE, and esophageal carcinoma. Multivariate analysis was utilized to identify factors that increase the propensity to develop BE and esophageal carcinoma. Statistical significance was p < 0.050. RESULTS:One hundred sixty five thousand nine hundred twenty nine obese patients on PPI treatment were identified up until July 2017. Median follow-up time was 119.0 months (range 11.3-1397.9 months). In patients with GERD, the following were associated with increased BE risk: age ≥ 60 years (OR = 1.197; p = 0.039), male (OR = 2.209; p < 0.001), H2 antagonists (OR = 1.377; p < 0.001), D2 antagonists (OR = 1.241; p = 0.008), and hiatus hernias (OR = 6.772; p = 0.017). The following were associated with increased risk of esophageal carcinoma: age (OR = 2.831; p = 0.031), male sex (OR = 3.954; p = 0.003), and hiatus hernias (OR = 12.170; p < 0.001). Only D2 antagonists (OR = 2.588; p = 0.002) were associated with increased risk of developing esophageal carcinoma in BE patients. CONCLUSIONS:In obese patients on PPI therapy for reflux, higher BMIs were not associated with increased risk of BE or esophageal carcinoma. Males, older patients, and those with hiatus hernias are at increased risk of developing BE and carcinoma. Failure of PPI monotherapy is predictive of future metaplasia and dysplasia.

Project description:Background/aimsRespiratory symptoms are often associated with gastroesophageal reflux disease (GERD). Although the role of multichannel intraluminal impedance-pH (MII-pH) monitoring in GERD is clear, little is known regarding the characteristics of patients with respiratory symptoms based on MII-pH monitoring and anti-reflux therapy. We evaluated a cohort of GERD patients to identify the MII-pH parameters of GERD-related respiratory symptoms and to assess the anti-reflux therapy outcomes.MethodsWe undertook a prospective study of patients who were referred for GERD evaluation from January 2011 to January 2012. One hundred ninety-five patients underwent MII-pH monitoring and esophageal manometry, and one hundred sixty-five patients underwent invasive anti-reflux therapy that included laparoscopic Toupet fundoplication (LTF) and the Stretta procedure. The patient characteristics and MII-pH parameters were analyzed, and the symptom scores were assessed at baseline and at 1- and 3-year follow-up evaluations.ResultsOf the 195 patients, 96 (49.2%) exhibited respiratory symptoms and significantly more reflux episodes (70.7±29.3) than patients without respiratory symptoms (64.7±24.4, p = 0.044) based on the MII-pH monitoring results. Moreover, the group of patients with respiratory symptoms exhibited more proximal reflux episodes (35.2±21.3) than the non-respiratory symptomatic group (28.3±17.9, p = 0.013). One hundred twenty-five patients following the Stretta procedure (n = 60, 31 with respiratory symptoms) or LTF (n = 65, 35 with respiratory symptoms) completed the designated 3-year follow-up period and were included in the final analysis. The symptom scores after anti-reflux therapy all decreased relative to the corresponding baseline values (p<0.05), and there were no significant differences in the control of respiration between the Stretta procedure and LTF (p>0.05). However, LTF significantly reduced the recurrence (re-operation) rate compared with the Stretta procedure (0 vs. 19.4%, p = 0.006).ConclusionsMII-pH monitoring effectively detected respiratory-related predictive parameters, including total/proximal reflux episodes and symptom correlations. We found that GERD patients with respiratory symptoms exhibited more proximal and total reflux episodes but not more acid-related episodes, as determined by MII-pH monitoring. Thus, such monitoring could be useful for diagnosing atypical GERD patients with respiratory symptoms. Furthermore, LTF exhibited a more significant effect on controlling typical symptoms in all GERD patients and reducing the recurrence rate than the Stretta procedure in patients with respiratory symptoms.

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GERD assessment including pH metry predicts a high response rate to PPI standard therapy.

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GERD assessment including pH metry predicts a high response rate to PPI standard therapy.

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