Research Report
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World J Gastroenterol. Apr 14, 2014; 20(14): 4017-4024
Published online Apr 14, 2014. doi: 10.3748/wjg.v20.i14.4017
Positive predictors for gastroesophageal reflux disease and the therapeutic response to proton-pump inhibitors
Valentin Becker, Stefan Grotz, Christoph Schlag, Simon Nennstiel, Analena Beitz, Bernhard Haller, Roland M Schmid, Alexander Meining, Monther Bajbouj
Valentin Becker, Stefan Grotz, Christoph Schlag, Simon Nennstiel, Analena Beitz, Roland M Schmid, Alexander Meining, Monther Bajbouj, II. Medizinische Klinik und Poliklinik, Technische Universität München, D-81675 Munich, Germany
Bernhard Haller, Institut für Medizinische Statistik und Epidemiologie, Technische Universität München, D-81675 Munich, Germany
Author contributions: Becker V, Schmid RM, Meining A and Bajbouj M contributed to study design; Becker V, Schlag C and Nennstiel S contributed to pH-metry, Impedance Monitoring; Grotz S, Beitz A and Haller B contributed to data collection and statistics.
Correspondence to: Valentin Becker, MD, II. Medizinische Klinik, Technische Universität München, Klinikum Rechts der Isar, Ismaningerstr. 22, D-81675 Munich, Germany. valentin.becker@lrz.tum.de
Telephone: +49-89-41405847 Fax: +49-89-41404816
Received: October 7, 2013
Revised: December 20, 2013
Accepted: January 8, 2014
Published online: April 14, 2014
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: Gastroesophageal reflux, Gastroesophageal reflux disease, Non-erosive reflux disease, Impedance pH measurement, Follow-up, Therapy, Proton pump inhibitor

Core tip: The response rates to proton pump inhibitors in reflux disease vary. Empirical proton pump inhibitor therapy poses a substantial economic burden. Positive predictors of the therapeutic response are necessary. This study provides the highest number of reflux patients. Anamnestic, objective and subjective parameters predicting the therapeutic response were evaluated.