High-dose Proton-Pump Inhibitors as a Diagnostic Test of Gastro-oesophageal Reflux Disease in Endoscopic-negative Patients

Abstract

60 mg lansoprazole once daily for 5 days is an easy to use method for diagnosing GORD in endoscopy-negative patients. Using 24-h oesophageal pH monitoring as the reference method, the sensitivity was relatively high, while the specificity was lower. Further studies are needed to determine how a PPI could be used as a diagnostic test in GORD.

A poor response to proton pump inhibition is not a contraindication for laparoscopic antireflux surgery for gastro esophageal reflux disease

“…In fact, it has been suggested that patients with a poor response to PPIs may not have GORD and therefore should not be offered further investigation or surgery. Juul-Hansen et al [11] supported this view in a Norwegian study of the efficacy of high-dose lansoprazole in reducing antacid consumption and its sensitivity as a diagnostic tool for GORD [11]. Campos et al [7], in a miultivariate analysis of factors predicting outcome after LARS, found that a good response to PPIs was a strong predictor of successful outcome.…”

Obesity as a risk factor for GERD in Japan

“…This questionnaire, however, includes questions about the effects of antacids, which are not prescribed in clinical practice in Japan, and a total of 26 sections of questions have to be answered, which can be inconvenient. On the other hand, heartburn and waterbrash are typical symptoms of GERD, [9][10][11] have a high specifi city for GERD, 12 and also indicate GERD severity. In this study, we used a questionnaire defi ning NERD as heartburn and waterbrash symptoms twice or more per week even if no mucosal break was seen on endoscopic examination.…”

What is the place of empirical proton pump inhibitor testing in the diagnosis of gastroesophageal reflux disease? (Description, duration, and dosage)

“…Questionnaires and symptom records were used in most studies for the assessment of PPI response; although the symptom response threshold varied according to the study, in comparison with the beginning of the test, a 50%-75% recovery in symptoms was acceptable. A significant difference was not detected among PPIs in terms of effectiveness (10-12).Although the sensitivity of the PPI test is 27%-89% in patients with typical symptoms of GERD, its specificity is 35%-83% (2,(4)(5)(6)(7)(8)13,14). Because of the use of different methods and populations in studies, it is quite difficult to make comparisons.…”

“…Although the sensitivity of the PPI test is 27%-89% in patients with typical symptoms of GERD, its specificity is 35%-83% (2,(4)(5)(6)(7)(8)13,14). Because of the use of different methods and populations in studies, it is quite difficult to make comparisons.…”

“…Although the specificity was found to be 36% in the prospective study of Johnsson et al (22) that consisted of 440 patients and was performed comparatively in both upper gastrointestinal endoscopy or 24h pH monitoring with 40 mg/day esomeprazole for 2 weeks, it was indicated that the PPI test could be used for the diagnosis of GERD. The sensitivity of the PPI test that was performed for 5 days with 60 mg/day lansoprazole in patients who were endoscopically detected as GERD negative and in pH-metric-controlled patients was found to be 85% and the specificity was found to be 73% (8). In the PPI test that Schindlbeck et al (4) performed in endoscopy-negative cases in 2 different omeprazole doses for 1 week (40 mg/day and 40 mg bid), they found that the sensitivity was 27% for the dose of 40 mg/day and 83% for the dose of 40 mg bid.…”