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Positive predictors for gastroesophageal reflux disease and the therapeutic response to proton-pump inhibitors Becker V; Grotz S; Schlag C; Nennstiel S; Beitz A; Haller B; Schmid RM; Meining A; Bajbouj MWorld J Gastroenterol 2014[Apr]; 20 (14): 4017-24AIM: To identify objective and subjective predictors for the reliable diagnosis of gastroesophageal reflux disease (GERD) and the response to proton pump inhibitor (PPI) therapy. METHODS: Retrospectively, 683 consecutive patients suspected for GERD who underwent pH-metry/impedance measurement (pH/MII) were analyzed. All patients had previously undergone standard PPI treatment (e.g., pantoprazole 40 mg/d or comparable). Four hundred sixty patients were at least 10 d off PPIs (group A), whereas 223 patients were analyzed during their ongoing PPI therapy (group B). In addition, all patients completed a standardized symptom- and lifestyle-based questionnaire, including the therapeutic response to previous PPI trials on a 10-point scale. Uni- and multivariance analyses were performed to identify criteria associated with positive therapeutic response to PPIs. RESULTS: In group A, positive predictors (PPs) for response in empirical PPI trials were typical GERD symptoms (heartburn and regurgitation), a positive symptom index (SI) and pathological results in pH/MII, along with atypical symptoms, including hoarseness and fullness. In group B, regular alcohol consumption was associated with the therapeutic response. The PPs for pathological results in pH/MII in group A included positive SI, male gender, obesity, heartburn and regurgitation. In group B, the PPs were positive SI and vomiting. Analyzing for positive SI, the PPs were pathological pH and/or MII, heartburn regurgitation, fullness, nausea and vomiting in group A and pathological pH and/or MII in group B. CONCLUSION: Anamnestic parameters (gender, obesity, alcohol) can predict PPI responses. In non-obese, female patients with non-typical reflux symptoms, pH/MII should be considered instead of empirical PPIs.|2-Pyridinylmethylsulfinylbenzimidazoles/therapeutic use[MESH]|Adult[MESH]|Aged[MESH]|Electric Impedance[MESH]|Esophageal pH Monitoring[MESH]|Female[MESH]|Gastroesophageal Reflux/*diagnosis/*drug therapy[MESH]|Heartburn[MESH]|Humans[MESH]|Hydrogen-Ion Concentration[MESH]|Life Style[MESH]|Male[MESH]|Middle Aged[MESH]|Multivariate Analysis[MESH]|Pantoprazole[MESH]|Predictive Value of Tests[MESH]|Proton Pump Inhibitors/*therapeutic use[MESH]|ROC Curve[MESH]|Retrospective Studies[MESH]|Surveys and Questionnaires[MESH]|Treatment Outcome[MESH] |
