Endoscopy‐negative reflux disease: what is the value of a proton‐pump inhibitor test in everyday clinical practice?

Abstract

Application of a diagnostic PPI test in clinical practice gave a high sensitivity and unusually low specificity compared to placebo-controlled studies, indicating that a test of this nature should be used with caution in everyday practice. Most patients with endoscopy-negative GORD will be diagnosed clinically. A positive test with PPI strengthens the diagnosis but has insufficient specificity to be an objective criterion alone. pH-metry should be unnecessary for the diagnosis of ENGORD in patients with typical reflux symptoms.

Assessing different diagnostic tests for gastroesophageal reflux disease: a systematic review and network meta-analysis

“…After full-text review, studies unrelated to diagnostic tests for GERD ( n = 23), studies not in English/Chinese language ( n = 2), and studies not eligible for enrollment ( n = 3) were excluded. Altogether, a total of 40 published studies meeting the predetermined inclusion criteria were identified 13–52 (Figure 1).…”

A Comparison Between Sodium Alginate and Magaldrate Anhydrous in the Treatment of Patients with Gastroesophageal Reflux Symptoms

“…On the basis of this observation, the use of a single sodium alginate dose as a diagnostic tool in patients with symptoms suggestive of GOR seems promising, although this requires further investigation before being formally proposed. Indeed, since the currently used standard short-term treatment with proton pump inhibitors as a test for GOR (PPI test) requires a 1-to 2-week period of high-dose treatment and has a sensitivity of approximately 80%, with a poor specificity [15,16], use of a single dose of sodium alginate might exhibit a higher sensitivity, better compliance derived from single dosing, and rapid interpretation of results.…”

Ante un paciente con síntomas típicos de enfermedad por reflujo gastroesofágico (ERGE) y sin síntomas de alarma, ¿cuál es la dosis y la duración más apropiada del tratamiento empírico con inhibidores de la bomba de protones que nos permitirá concluir si realmente se trata de una ERGE?

“…La prueba del IBP tiene igual fundamento, pero presenta algunas diferencias debidas a su objetivo diagnóstico 12 . Se ha experimentado con todos los IBP disponibles administrados habitualmente en una dosis mayor de la convencional (por lo común doble) y durante un plazo más corto (5-15 días) [13][14][15][16][17][18][19][20] . Se considera positiva, esto es, diagnóstica de ERGE, cuando se constata la remisión o la mejoría significativa de los síntomas (descenso del 50-75% del índice sintomático).…”