Document Detail

Limited Ability of the Proton-Pump Inhibitor Test to Identify Patients with Gastroesophageal Reflux Disease.
MedLine Citation:
PMID:  22813439     Owner:  NLM     Status:  Publisher    
BACKGROUND & AIMS: The efficacy of proton-pump inhibitor (PPI) therapy is often assessed to determine whether patients' symptoms are acid-related and if patients have gastroesophageal reflux disease (GERD), although the accuracy of this approach is questionable. We evaluated the diagnostic performance of the PPI test, in conjunction with other tests, for the diagnosis of GERD. METHODS: We analyzed data from the DIAMOND Study, a multi-national trial that compared the ability of the reflux disease questionnaire with that of symptom-based clinical diagnosis to identify GERD in primary-care patients with frequent upper gastrointestinal symptoms. Patients (n=308) were given placebo and further evaluated by endoscopy, wireless esophageal pH-metry, and symptom association monitoring (SAP). Those with GERD (n=197) were identified based on the presence of reflux esophagitis, esophageal pH<4 for >5.5% of 24 h, or positive results from SAP (or a positive result from the PPI test, in patients with borderline levels of esophageal acidity). All patients were then given single-blind therapy with esomeprazole (40 mg once daily) for 2 weeks and symptoms were recorded daily. RESULTS: A positive response to the PPI test was observed in 69% of patients with GERD and 51% of those without GERD. Response to placebo did not influence the diagnostic ability of the subsequent PPI test. More patients with reflux esophagitis had a positive result from the PPI test than patients without GERD (57% vs 35%; P =.002) or patients with GERD but no esophagitis. A clinical diagnosis by the primary care physician of an acid-related disease was not associated with response to PPIs. CONCLUSIONS: In a well-characterized population of primary care patients with frequent upper gastrointestinal symptoms of any type, the PPI test has limited ability to identify patients with GERD, diagnosed by current standard tests.
Peter Bytzer; Roger Jones; Nimish Vakil; Ola Junghard; Tore Lind; Börje Wernersson; John Dent
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-16
Journal Detail:
Title:  Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association     Volume:  -     ISSN:  1542-7714     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101160775     Medline TA:  Clin Gastroenterol Hepatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.
Køge University Hospital and Copenhagen University, Copenhagen, Denmark.
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