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

Zerbib, Frank; Belhocine, K.; Simon, M.; Capdepont, Maylis; Mion, François; Varannes, Stanislas Bruley des; Galmiche, Jean–Paul

doi:10.1136/gutjnl-2011-300798

Cited by 115 publications

(108 citation statements)

References 36 publications

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“…It has been revealed that 37%-60% of NERD patients have normal acid reflux, and the proportion of FH and RH can vary from less than 10% to 75% and to 36%, respectively. [14][15][16][17][18][19][20][21][22][23][24][25] One factor that has contributed to the variation is the changing definitions of heartburn phenotypes. For example, the Rome III committee used to define those with normal reflux but positive symptom-reflux association as NERD, but these patients were then isolated as a single group named RH in the updated criteria.…”

Section: Discussionmentioning

confidence: 99%

The Rome IV versus Rome III criteria for heartburn diagnosis: A comparative study

Zhang

Chen

Peng

et al. 2017

United European Gastroenterology Journal

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Background: The phenotypes of heartburn patients are heterogeneous. Objective: The objective of this study was to investigate the proportion of heartburn phenotypes in a Chinese population and to compare the Rome IV and III criteria for heartburn diagnosis. Methods: A retrospective study was performed among heartburn patients referred for upper endoscopy and esophageal function tests in a tertiary hospital. Their symptoms fulfilled Rome IV and III criteria. Results: A total of 233 patients were included. Fifty-nine patients (25%) were diagnosed with esophagitis, 96 (41%) with non-erosive reflux disease (NERD) and 78 (34%) with functional heartburn (FH) based on Rome III criteria. Approximately 70% of the Rome III NERD patients were changed based on Rome IV criteria, with 36 patients (15%) diagnosed with reflux hypersensitivity (RH) and 32 patients (14%) who didn't fulfill the criteria considered unclassified. The FH and RH patients showed higher esophagogastric junction-contractile integral (EGJ-CI) and less hiatal hernia than did Rome IV NERD patients. The unclassified had more hiatal hernias than the FH and RH (p < 0.05). The EGJ-CI was similar between Rome III NERD and FH cases. Conclusion: The Rome IV criteria were stricter for heartburn diagnosis and superior in distinguishing NERD from functional disorders on motility patterns than Rome III. KeywordsHeartburn, gastroesophageal reflux disease, function esophageal disorders, Rome III criteria, Rome IV criteria, screening and diagnosis non-erosive reflux disease (NERD) cases, among whom approximately 34% had functional heartburn (FH) and 15% had reflux hypersensitivity (RH). . The Rome IV criteria were superior to the Rome III criteria in distinguishing NERD from FH and RH according to motility characteristics. Approximately 14% of the patients didn't fit the updated criteria.

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Section: Discussionmentioning

confidence: 99%

The Rome IV versus Rome III criteria for heartburn diagnosis: A comparative study

Zhang

Chen

Peng

et al. 2017

United European Gastroenterology Journal

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“…Previous studies reported co-existing FD as a factor predicting PPI failure in GERD patients. Recently, Zerbib et al [20] reported that FD and irritable bowel syndrome are strongly associated with PPI failure in patients with documented reflux. However, there are no studies reporting factors that predict P-CAB failure.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Potassium-Competitive Acid Blocker Non-Response in Patients with Proton Pump Inhibitor-Refractory Gastroesophageal Reflux Disease

et al. 2017

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Background/Aims: Approximately 20-40% of patients with gastroesophageal reflux disease (GERD) are refractory to proton pump inhibitor (PPI) treatment. The acid-inhibitory effect of vonoprazan, a novel potassium-competitive acid blocker (P-CAB), is significantly greater when compared to the effect of PPIs. We investigated the efficacy of vonoprazan treatment for PPI-refractory GERD and factors associated with P-CAB non-response. Methods: We enrolled 277 GERD patients receiving continuous PPI therapy. Subjects completed a self-report questionnaire including the frequency scale for the symptoms of GERD (FSSG). Patients with PPI-refractory GERD received 20 mg of vonoprazan once daily for 8 weeks. After that, subjects completed the same questionnaire, and the results were used to identify P-CAB responders and non-responders. Results: Twenty-eight patients were identified as P-CAB responders and 26 were non-responders. Vonoprazan treatment significantly decreased scores of FSSG, nighttime symptom, and Athens Insomnia Scale. Multivariate analysis demonstrated co-existing functional dyspepsia (FD; OR 4.94) and the presence of sleep disturbances (OR 4.34) was associated with P-CAB non-response, whereas alcohol consumption was inversely associated. Conclusions: Vonoprazan treatment might be appropriate as a promising new strategy for PPI-refractory GERD. Co-existing FD, sleep disturbances, and alcohol abstinence were significantly associated with P-CAB non-response. Other therapeutic options should be considered in patients with these factors.

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“…Our results concur with those in the literature in that impedance monitoring detects more reflux events than pH monitoring. Although previous assessments suggest that the clinical value and optimal use of symptom-reflux correlation remain unclear (33,34), we demonstrate that SAP from impedance testing is an independent predictor of symptomatic outcome after medical therapy of GERD. Despite this finding, only limited outcome data exist to suggest a relationship between non-acidic reflux detected by impedance testing and symptoms in suspected GERD (35).…”

Section: Discussionmentioning

confidence: 53%

816 Acid-Based Parameters on pH-Impedance Testing Predict Symptom Improvement With Medical Management Better Than Impedance Parameters

Patel¹,

Sayuk²,

Gyawali³

2013

Gastroenterology

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

Abstract: No 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/m(2) are strongly associated with PPI failure.

Cited by 115 publications

References 36 publications

The Rome IV versus Rome III criteria for heartburn diagnosis: A comparative study

The Rome IV versus Rome III criteria for heartburn diagnosis: A comparative study

Factors Associated with Potassium-Competitive Acid Blocker Non-Response in Patients with Proton Pump Inhibitor-Refractory Gastroesophageal Reflux Disease

816 Acid-Based Parameters on pH-Impedance Testing Predict Symptom Improvement With Medical Management Better Than Impedance Parameters

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