Endoscopic measurement of gastric pH is associated with persistent acid reflux in patients treated with proton pump inhibitors for gastroesophageal reflux disease

Abstract

Background Proton-pump inhibitors (PPIs) are the mainstay of gastroesophageal reflux disease (GERD) treatment, however, up to 30% of patients have a poor symptomatic response. PH-impedance is the gold standard to assess whether this is due to persistent acid reflux. We aimed to characterize clinical predictors of persistent esophageal acid reflux on PPIs including gastric pH measured during endoscopy. Methods We prospectively recruited patients with GERD and/or Barrett’s esophagus (BE) on PPIs. All patients completed a symptom questionnaire (RDQ) and underwent gastroscopy with gastric pH analysis, immediately followed by ambulatory 24-hour pH-impedance. We used a modified cut-off of 1.3% for pathological esophageal acid exposure time (AET). Multiple linear regression model was used to analyze the correlation between AET and predictive variables. Results We recruited 122 patients, of which 92 (75.4%) were included in the final analysis [44 male (47.8%), median age 53 years (IQR: 43–66)]. Forty-four patients (47.8%) had persistent acid reflux with a median total AET of 2.2 (IQR1.2-5.0), as compared to 0.1 (IQR 0.0-0.2) in patients without persistent reflux (n=48; P<.001). There was no difference in age, gender, BMI, PPI-regimen, diagnosis of hiatus hernia or BE, and severity of symptoms between patients with normal and abnormal AET. Median gastric pH was significantly lower in patients with abnormal AET (5.8 vs 6.6, P=0.032) and it correlated with the total AET (P=.045; R2=12.0%). With a pH cut-off of 5.05, single point endoscopic gastric pH analysis had an area under the ROC curve (AUC) of 63.0% (95%CI 51.3-74.7) for prediction of pathological esophageal AET. Conclusions Symptoms and clinical characteristics are not useful to predict persistent acid reflux in patients on PPIs. One-point gastric pH correlates with 24-hour esophageal AET and could guide clinicians to assess response to PPIs, however, its utility needs validation in larger studies.

Analysis of current approaches to the treatment and quality of life improvement in patients with gastroesophageal reflux disease in case of its combination with the syndrome of undifferentiated connective tissue dysplasia

“…Drugs of choice for GERD pharmacotherapy are antisecretory agents and primarily proton pump inhibitors (PPIs) (Sawada, 2020;Sharma, Yadlapati, 2020;Surdea-Blaga, 2016). Two ways can also be used to increase the effectiveness of treatment and the rapid elimination of symptoms, including the combination of PPIs with alginates, antacids, or prokinetics or increasing the dose of the drug (Januszewicz, 2019). The expediency of the use of pharmaceuticals aimed at protecting the mucous membrane of the esophagus is due to the pathogenesis of GERD, namely -cellular and molecular mechanisms of inflammatory changes in the mucous membrane of the esophagus.…”

UEGWeek: The modern School of Athens

“…A real‐time measure of the pH during endoscopy was able to provide, on 122 prospectively enrolled patients, a good correlation with the 24‐h esophageal acid exposure time on pH impedance 1 …”

“…A real-time measure of the pH during endoscopy was able to provide, on 122 prospectively enrolled patients, a good correlation with the 24-h esophageal acid exposure time on pH impedance. 1 Still related to the esophagus (and also stomach), the use of probe-based confocal laser endomicroscopy (p-CLE) on 74 lesions was investigated, with p-CLE providing overall diagnostic accuracy for malignant lesions of 89%, versus biopsies with 85% of accuracy. 2 The advent of new devices in the endoscopy field was also highlighted in a study on the use of Hemospray where a single-arm, prospective multicenter study on 73 patients reported a rate of immediate hemostasis achieved in 100%, with only 4% of patients suffering from re-bleeding and no adverse events due to the use of Hemospray.…”

“…Among the almost 6000 abstracts submitted to 2019 and 2020 UEGWeek editions, 32 were then accepted as full‐text publication to UEG Journal 1–31 . Here we will summarize these “hot” papers (see also Figure 3).…”

Pharmacokinetics and Pharmacodynamics of Lansoprazole/Sodium Bicarbonate Immediate‐release Capsules in Healthy Chinese Subjects: An Open, Randomized, Controlled, Crossover, Single‐, and Multiple‐dose Trial

“…Real-time monitoring of intragastric pH after PPI administration using a pH monitor may be a valuable tool for investigators comparing PD parameters between study drugs. 17,18 The intragastric pH level was automatically and continuously recorded by a pH monitor (Ohmega R; Enschede, The Kingdom of the Netherlands) and MMS Database software. A flexible, single-use, single-channel antimony pH catheter (ZandorpH Laborie; Enschede, The Kingdom of the Netherlands) was introduced through the nasopharynx to reach the stomach.…”