Rabeprazole test for the diagnosis of gastro-oesophageal reflux disease: Results of a study in a primary care setting

Abstract

AIM: T o d e t e r m i n e t h e d i a g n o s t i c v a l u e o f t h e rabeprazole test in patients seen by general practitioners. METHODS:Eighty-three patients with symptoms s u g g e s t i v e o f G E R D w e r e e n r o l l e d b y g e n e r a l practitioners in this multi-centre, randomized and doubleblind study. All patients received either rabeprazole (20 mg bid) or a placebo for one week. The diagnosis of GERD was established on the presence of mucosal breaks at endoscopy and/or an abnormal esophageal 24-h pH test. The test was considered to be positive if patients reported at least a "clear improvement" of symptoms on a 7-point Likert scale. RESULTS:The sensitivities of the test for rabeprazole and the placebo were 83% and 40%, respectively. The corresponding specificity, positive and negative predictive values were 45% and 67%, 71% and 71%, and 62% and 35%, respectively. A receiver operating characteristics (ROC) analysis confirmed that the best discriminatory cut-off corresponded to description of "clear improvement". CONCLUSION:The poor specificity of the proton-pump inhibitor (PPI) test does not support such an approach to establish a diagnosis of GERD in a primary care setting.

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).…”

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.…”

The Rome III Classification of Dyspepsia: Will It Help Research?

“…However, dominant heartburn is a poor predictor for identifying objective findings such as reflux esophagitis [17] . EPS and PDS may still be diagnosed to be present according to Rome III if there is uncertainty and dyspepsia persists despite a trial of adequate anti-secretory therapy, although the proton pump inhibitor test as a means for identifying GERD remains suboptimal [18] .…”