Brief Article
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World J Gastroenterol. May 28, 2013; 19(20): 3124-3129
Published online May 28, 2013. doi: 10.3748/wjg.v19.i20.3124
Risk factors for proton pump inhibitor refractoriness in Chinese patients with non-erosive reflux disease
Xiao-Ping Niu, Bao-Ping Yu, Yun-Dong Wang, Zhen Han, Shao-Fen Liu, Chi-Yi He, Guo-Zheng Zhang, Wan-Chun Wu
Xiao-Ping Niu, Zhen Han, Shao-Fen Liu, Chi-Yi He, Guo-Zheng Zhang, Wan-Chun Wu, Department of Gastroenterology, Yijishan Hospital, Wannan Medicine College, Wuhu 241001, Anhui Province, China
Bao-Ping Yu, Yun-Dong Wang, Department of Gastroenterology, Renmin Hospital, Wuhan University, Wuhan 430060, Hubei Province, China
Author contributions: Yu BP designed and supervised the study; Han Z instructed the study; Niu XP conceived and designed the study, collected and compiled the patient data, performed the scale survey, wrote the manuscript and gave final approval of the version to be published; Wang YD and Liu SF performed the scale survey and the questionnaire on patient general status and lifestyle; He CY compiled the data and performed the statistical analysis; Wu WC and Zhang GZ collected the cases and enrolled the patients.
Correspondence to: Bao-Ping Yu, MD, Department of Gastroenterology, Renmin Hospital, Wuhan University, No. 99 Zhangzhidong Road, Wuchang District, Wuhan 430060, Hubei Province, China. baopingyu@yahoo.cn
Telephone: +86-27-88041911 Fax: +86-27-88042292
Received: January 14, 2013
Revised: March 20, 2013
Accepted: April 9, 2013
Published online: May 28, 2013
Abstract

AIM: To analyze risk factors for refractoriness to proton pump inhibitors (PPIs) in patients with non-erosive reflux disease (NERD).

METHODS: A total of 256 NERD patients treated with the PPI esomeprazole were enrolled. They were classified into symptom-free and residual symptoms groups according to Quality of Life in Reflux and Dyspepsia (QolRad) scale. All subjects completed questionnaires on psychological status (self-rating anxiety scale; self-rating depression scale) and quality of life scale (Short Form 36). Multivariate analysis was used to determine the predictive factors for PPI responses.

RESULTS: According to QolRad, 97 patients were confirmed to have residual reflux symptoms, and the remaining 159 patients were considered symptom free. There were no significant differences between the two groups in lifestyle factors (smoking and alcohol consumption), age, Helicobacter pylori infection, and hiatal hernia. There were significant differences between the two groups in relation to sex, psychological distress including anxiety and depression, body mass index (BMI), and irritable bowel syndrome (IBS) (P < 0.05). Logistic regression analysis found that BMI < 23, comorbid IBS, anxiety, and depression were major risk factors for PPI resistance. Symptomatic patients had a lower quality of life compared with symptom-free patients.

CONCLUSION: Some NERD patients are refractory to PPIs and have lower quality of life. Residual symptoms are associated with psychological distress, intestinal disorders, and low BMI.

Keywords: Risk factors, Refractoriness, Proton pump inhibitors, Non-erosive reflux disease

Core tip: Non-erosive reflux disease (NERD) is significantly more refractory to proton pump inhibitor (PPI) treatment than erosive esophagitis is, although the reason is unclear at present. Here, we investigated the risk factors for refractoriness to PPI treatment in patients with NERD. Our results demonstrate that some NERD patients are refractory to standard doses of PPIs and have a lower quality of life. Residual symptoms are associated with psychological distress, intestinal disorders, and low body mass index. Recognition of this might hold the key to improving long-term management of NERD.