PPI therapy is equally effective in well‐defined non‐erosive reflux disease and in reflux esophagitis: a meta‐analysis

Weijenborg, Pim W.; Cremonini, Filippo; Smout, A. J. P. M.; Bredenoord, Albert J.

doi:10.1111/j.1365-2982.2012.01888.x

Cited by 133 publications

(99 citation statements)

References 97 publications

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“…Since NERD is well defined in the Rome IV criteria, PPI therapy was almost equally effective among patients with real NERD and RE in the current study, which was consistent with other previous studies. 31 Excessive esophageal acid exposure is the main pathophysiological mechanism of real GERD, whereas visceral hypersensitivity is more prominent for RH and FH. 32 This can explain, to some extent, the lower responsiveness of routine PPI treatment among RH and FH patients.…”

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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“…Currently about 20% to 30% GERD patients have inadequate response to the proton pump inhibitor (PPI) treatment. 10 Esophageal baseline impedance may become a candidate as a predictor for treatment efficacy due to the potential association with the severity of acid exposure, but there is still lack of sufficient evidence to support this hypothesis. Thus, the aims of the current study are (1) to define the baseline impedance pattern of NERD patients, (2) to assess whether the baseline impedance correlated to the severity of esophageal acid exposure and DIS, and (3) to find out whether DIS and the baseline impedance can predict on the efficacy of PPI treatment.…”

Section: Introductionmentioning

confidence: 99%

Esophageal Baseline Impedance Reflects Mucosal Integrity and Predicts Symptomatic Outcome With Proton Pump Inhibitor Treatment

Xie

Sifrim

et al. 2018

J Neurogastroenterol Motil

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Background/AimsEsophageal baseline impedance, which is decreased in gastroesophageal reflux disease (GERD) patients, is related to the severity of acid reflux and the integrity of the esophageal mucosa. The study aims to compare the baseline impedance and the dilated intercellular spaces (DIS) within patients with typical reflux symptoms and to evaluate the correlation of baseline impedance with DIS, esophageal acid exposure, as well as the efficacy of proton pump inhibitor (PPI) treatment. MethodsNinety-two patients and 10 healthy controls were included in the study. Erosive esophagitis (EE) was defined by esophageal mucosal erosion under upper endoscopy. Patients without mucosa erosion were divided into groups with pathologic acid reflux (nonerosive reflux disease [NERD]) or with hypersensitive esophagus. The biopsies of esophageal mucosa were taken 2-4 cm above the gastroesophageal junction Z-line during upper endoscopy for DIS measurement. All the patients received esomeprazole 20 mg twicedaily treatment for 8 weeks. The efficacy of esomeprazole was evaluated among all patients. ResultsThe intercellular spaces were dilated in both EE and NERD patients (P < 0.05). The value 0.73 mm could be used as the cut-off DIS value to distinguish patients from controls (area under the curve [AUC] = 0.849, P < 0.01). One thousand seven hundred sixty-four ohms could be used as the cut-off impedance values to distinguish patients from controls (AUC = 0.794, P < 0.01). The baseline impedance was decreased in both EE patients and NERD patients, and negatively correlated to the acid exposure time (r = -0.527, P < 0.05). There was a weak correlation between DIS and baseline impedance (r = -0.230, P < 0.05). "Baseline impedance > 1764 Ω" was an independent predictor for PPI failure (OR, 11.9; 95% CI, 2.4-58.9; P < 0.01). ConclusionsThe DIS and decreased baseline impedance was observed in patients with mucosa erosion or pathological acid reflux. The baseline impedance reflected the mucosal integrity, it was more sensitive to esophageal acid exposure. Patients with high impedance might not benefit from the PPI treatment.

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“…In this regard, it is important to emphasize that weakly acidic reflux is not synonymous with bile reflux. A simultaneous Bilitech and MII-pH study showed no relationship between the percentage of time for bilirubin 77 February 15, 2016|Volume 7|Issue 1| WJGP|www.wjgnet.com absorbance and weakly acidic or weakly alkaline reflux. Indeed, this study showed that the greatest number of bile refluxes occurred concomitantly with acid refluxes [82] .…”

Section: Multichannel Intraluminal Impedance and Phmentioning

confidence: 99%

“…Overall, it is notable that NERD patients vary greatly from a pathophysiological point of view and should be accurately studied by means of MII-pH to undertake the best therapeutic approach [6] . Indeed, a meta-analysis found that the once defined low response rate in NERD was likely the result of the inclusion of patients with heartburn who did not have reflux disease [77] . Recently, the ability to perform MII-pH testing to understand GERD pathophysiology better has improved through the introduction of up and coming parameters, such as the post-reflux swallow-induced peristaltic wave (PSPW) index, which indicates the efficacy of esophageal clearance [78] , and baseline impedance values, which indicate the presence of a lack of integrity in the esophageal mucosa [79] .…”

Section: Multichannel Intraluminal Impedance and Phmentioning

confidence: 99%

Esophageal testing: What we have so far

Bortoli¹,

Martinucci²,

Bertani³

et al. 2016

WJGP

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Gastroesophageal reflux disease (GERD) is a common disorder of the gastrointestinal tract. In the last few decades, new technologies have evolved and have been applied to the functional study of the esophagus, allowing for the improvement of our knowledge of the pathophysiology of GERD. High-resolution manometry (HRM) permits greater understanding of the function of the esophagogastric junction and the risks associated with hiatal hernia. Moreover, HRM has been found to be more reproducible and sensitive than conventional water-perfused manometry to detect the presence of transient lower esophageal sphincter relaxation. Esophageal 24-h pH-metry with or without combined impedance is usually performed in patients with negative endoscopy and reflux symptoms who have a poor response to anti-reflux medical therapy to assess esophageal acid exposure and symptom-reflux correlations. In particular, esophageal 24-h impedance and pH monitoring can detect acid and non-acid reflux events. EndoFLIP is a recent technique poorly applied in clinical practice, although it provides a large amount of information about the esophagogastric junction. In the coming years, laryngopharyngeal symptoms could be evaluated with up and coming non-invasive or minimally invasive techniques, such as pepsin detection in saliva or pharyngeal pH-metry.

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PPI therapy is equally effective in well‐defined non‐erosive reflux disease and in reflux esophagitis: a meta‐analysis

Cited by 133 publications

References 97 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

Esophageal Baseline Impedance Reflects Mucosal Integrity and Predicts Symptomatic Outcome With Proton Pump Inhibitor Treatment

Esophageal testing: What we have so far

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