The Therapeutic and Diagnostic Value of 2-week High Dose Proton Pump Inhibitor Treatment in Overlapping Non-erosive Gastroesophageal Reflux Disease and Functional Dyspepsia Patients

Abstract

Background/AimsTo evaluate the value of a 2-week high dose proton pump inhibitor (PPI) treatment on patients with overlapping non-erosive gastroesophageal reflux disease (NERD) and functional dyspepsia (FD).MethodsSixty overlapping NERD and FD patients with symptom onset > 3 months prior underwent 24-hour esophageal pH monitoring studies. All patients received rabeprazole 20 mg b.i.d. for 2 weeks. The reflux and dyspeptic symptoms were evaluated using a symptom questionnaire with 4-point Likert scales before and at the end of treatment. A positive PPI test was defined as score improvement in ≥ 50% from the baseline in the typical reflux symptoms.ResultsThe prevalence of each reflux and dyspeptic symptom did not differ significantly between patients with positive and negative pH tests. After the PPI treatment, epigastric burning, acid regurgitation, heartburn, nausea, vomiting and chest discomfort scores were significantly improved compared to pretreatment values (P < 0.05), whereas postprandial abdominal fullness, early satiation, belching and food regurgitation were not. The proportion of patients who responded to the PPI treatment did not differ significantly between patients with positive and negative pH tests. The sensitivity, specificity, PPV, NPV and accuracy of 2-week high dose rabeprazole treatment for diagnosing gastroesophageal reflux disease were 47%, 38%, 50%, 35% and 43%, respectively.ConclusionsThe two-week high dose PPI treatment was not effective for early satiation, postprandial abdominal fullness, regurgitation or belching symptoms in patients with overlapping NERD and FD. Acid exposure in the distal esophagus could not predict the response of symptoms to PPI. In addition, the 2-week PPI test provided limited value for gastroesophageal reflux disease diagnosis in patients with overlapping NERD and FD.

Gastroesophageal reflux symptoms in typical and atypical GERD: Roles of gastroesophageal acid refluxes and esophageal motility

“…Each symptom was scored 0–3 according to its influence on patients' daily activities: 0, absent; 1, mild (symptoms presented but not interfere with daily activities); 2, moderate (symptoms presented and interfere with but not preclude daily activities); 3, severe (symptoms interfere with daily activities markedly enough to urge modification) . This questionnaire has been validated and used in our previous study . The patients who had heartburn and/or acid regurgitation as their main problem were classified as typical reflux symptom, and the patients who had upper abdominal pain or discomfort as their main problem, accompanying with any severity of heartburn and/or acid regurgitation, were classified as reflux‐like dyspepsia.…”

“…17 This questionnaire has been validated and used in our previous study. 8 The patients who had heartburn and/or acid regurgitation as their main problem were classified as typical reflux symptom, and the patients who had upper abdominal pain or discomfort as their main problem, accompanying with any severity of heartburn and/or acid regurgitation, were classified as reflux-like dyspepsia.…”

“…1 However, not only these typical GERD symptoms but also atypical symptoms such as noncardiac chest pain, chronic cough, hoarseness of voice, throat irritation, globus sensation, and increase throat secretion have been reported to be associated with GERD. [2][3][4][5] Esophageal motility disorders have been reported to be present in 25-48% of GERD patients [6][7][8] and increasing prevalence with increasing severity of reflux esophagitis. 7 The disorders were found to be associated with delayed clearance of gastroesophageal reflux contents 9,10 and may increase a prevalence of laryngopharyngeal refluxes.…”

Diaphragmatic Breathing Reduces Belching and Proton Pump Inhibitor Refractory Gastroesophageal Reflux Symptoms

“…7 It has been shown that SGB can exacerbate GERD symptoms by directly inducing reflux episodes. 3,5,6 PPIs are used widely in GERD treatment and have been used for belching, [8][9][10][11] but do not directly address the pathophysiology of SGB.…”

Chronic Burping and Belching

“…Proton-pump inhibitors (PPIs) which are commonly used in treatment of GERD symptoms are considered effective in reducing the number of belches as well [19][20][21][22]. Perhaps this can be explained by the notion that PPIs reduce the unpleasant abdominal or retrosternal sensation that triggers the behavior and leads to supragastric belching.…”