765 Symptom Reporting Among PPI Non Responders May Be Driven by Esophageal Hypervigilance and Not Reflux Phenotype

Keefer, Laurie; Craft, Jenna; Dowjotas, Kate; Kahrilas, Ian J.; Roman, Sabine; Pandolfino, John E.

doi:10.1016/s0016-5085(15)30500-x

Cited by 8 publications

(11 citation statements)

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“…One study evaluated physiological and psychosocial variables in a sample of PPI non‐responsive reflux participants that were stratified into four distinct GERD phenotypes. Results demonstrated hypervigilance scores did not significantly differ between the four groups 11 . A 2017 study assessed a myriad of factors associated with symptom perception in PPI non‐responders that were categorized into three groups (Normal, Abnormal, Reflux Hypersensitivity) based on 24‐hour pH‐impendence monitoring results.…”

Section: Discussionmentioning

confidence: 99%

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Esophageal hypervigilance is prevalent across gastroesophageal reflux disease presentations

Guadagnoli

Yadlapati

Taft

et al. 2021

Neurogastroenterology Motil

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Background There is a need to identify factors outside of abnormal reflux that contribute to gastroesophageal reflux disease (GERD). Esophageal hypervigilance is a psychological process impacting symptom experience in esophageal disease. However, little is known about the presence of hypervigilance in GERD phenotypes, especially in those with abnormal acid exposure or symptom index scores. The primary aim was to assess differences in self‐reported esophageal hypervigilance across different GERD presentations. The secondary aim was to evaluate esophageal hypervigilance as a predictor of symptom severity. Methods We conducted retrospective data analyses on a cohort of adult patients with reflux symptoms that underwent 96‐hour wireless pH monitoring from 9/2015 to 9/2017. Patients were stratified into groups based on the number of days they exhibited positive acid exposure time (AET; 0 days, 1–2 days, 3+ days), and symptom index scores (SI; 0 days, 1‐day, 2+ days). Esophageal hypervigilance and anxiety, and symptom frequency and severity were assessed between groups. Key Results A total of 123 AET cases and 116 SI cases were included for analysis. Esophageal hypervigilance and anxiety scores did not significantly differ based on the number of days of positive AET (p = 0.311) or SI (p = 0.118). Symptom severity and perceived symptom frequency differed between groups. Hypervigilance significantly predicted symptom severity, when controlling for symptom‐specific anxiety. Conclusions Esophageal hypervigilance is persistent across patients with reflux, irrespective of acid burden and symptom index, and significantly predicts symptom severity. Hypervigilance should be considered as an independent factor contributing to esophageal symptom perception.

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Section: Discussionmentioning

confidence: 99%

“…Esophageal hypervigilance is implicated as a crucial process contributing to the onset and maintenance of esophageal symptoms 9‐11 . To date, the majority of hypervigilance research in reflux populations is limited to functional heartburn, due to the role of brain‐gut axis dysregulation in the pathophysiology 12‐14 .…”

Section: Introductionmentioning

confidence: 99%

Esophageal hypervigilance is prevalent across gastroesophageal reflux disease presentations

Guadagnoli

Yadlapati

Taft

et al. 2021

Neurogastroenterology Motil

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“…Keefer et al previously demonstrated that esophageal hypervigilance, the heightened awareness of esophageal discomfort coupled with behavior out of proportion to the symptom experience, is elevated among PPI non-responders, regardless of physiologic profile 18 . This important work recognizes hypervigilance as a therapeutic target of PPI non-response across all levels of acid burden.…”

Section: Discussionmentioning

confidence: 99%

Psychosocial Distress and Quality of Life Impairment Are Associated With Symptom Severity in PPI Non-Responders With Normal Impedance-pH Profiles

Yadlapati

Tye

Keefer

et al. 2018

American Journal of Gastroenterology

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“…Hypervigilance begets hypervigilance and also results in an inability to enjoy symptom‐free periods, negatively impacting quality of life . A recent analysis of 70 patients with PPI‐refractory symptoms studied with pH‐impedance monitoring and psychometric testing came to the surprising conclusion that, regardless of patient phenotype in terms of positive or negative symptom correlation and normal or abnormal esophageal acid exposure, the unifying characteristic of all phenotypes was hypervigilance . In fact, hypervigilance accounted for 50% of patient‐reported symptom severity.…”

Section: Alternative Explanations For Persistent Symptomsmentioning

confidence: 99%

“…33 A recent analysis of 70 patients with PPI-refractory symptoms studied with pH-impedance monitoring and psychometric testing came to the surprising conclusion that, regardless of patient phenotype in terms of positive or negative symptom correlation and normal or abnormal esophageal acid exposure, the unifying characteristic of all phenotypes was hypervigilance. 34 In fact, hypervigilance accounted for 50% of patient-reported symptom severity. Psychological distress (depression, anxiety, somatization) on the other hand, was found to be within normal limits in all phenotypes.…”

Section: Alternative Explanations For Persistent Symptomsmentioning

confidence: 99%

Patients with refractory reflux symptoms: What do they have and how should they be managed?

Kahrilas

Keefer

Pandolfino

2015

Neurogastroenterology Motil

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With the widespread use of PPIs, the frontier of treating reflux disease has shifted from refractory esophagitis to PPI-refractory symptoms. However, symptoms are inherently less specific than mucosal disease and, as noted by Herregods et al in their contribution appearing in this issue of Neurogastroenterology and Motility, patients with refractory GERD symptoms often do not have GERD. This review discusses potential etiologies for PPI-refractory symptoms. Three major concepts are explored: subendoscopic esophagitis, weakly acidic reflux events, and alternative explanations for persistent symptoms. With respect to subendoscopic esophagitis and unsuppressed reflux, ample evidence exists that these are present in PPI-refractory patients. The problem is that these findings are also often present in substantial numbers of individuals with a satisfactory response to PPI therapy. Hence, the emphasis shifts to determinants of symptom perception. The major conclusion of the review is that psychogenic factors such as hyperalgesia, allodynia, hypervigilance, and heightened anxiety are the most plausible explanations as the dominant determinants of PPI-refractory symptoms.

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765 Symptom Reporting Among PPI Non Responders May Be Driven by Esophageal Hypervigilance and Not Reflux Phenotype

Cited by 8 publications

References 0 publications

Esophageal hypervigilance is prevalent across gastroesophageal reflux disease presentations

Esophageal hypervigilance is prevalent across gastroesophageal reflux disease presentations

Psychosocial Distress and Quality of Life Impairment Are Associated With Symptom Severity in PPI Non-Responders With Normal Impedance-pH Profiles

Patients with refractory reflux symptoms: What do they have and how should they be managed?

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