Empirical trials in treatment of gastroesophageal reflux disease.
The assortment of diagnostic tests that are currently available for detecting gastroesophageal reflux disease (GERD) are invasive, costly and not readily available to community-based physicians. In contrast, a short course of high-dose proton pump inhibitor (PPI) as an empirical trial is an attractive alternative. This simple diagnostic test has been demonstrated to be accurate and cost-effective in patients with symptoms suggestive of GERD and those with noncardiac chest pain. Early studies in patients with extraesophageal manifestations of GERD have yielded promising results. Cost assessment of the PPI empirical trial revealed significant cost savings, mainly due to a marked decrease in utilization of invasive diagnostic tests. Thus the PPI empirical trial should be considered as the initial diagnostic step in patients with the disease spectrum of GERD.
Fass
R
R
Department of Medicine, Section of Gastroenterology, Southern Arizona V.A. Halth Care System and University of Arizona Health Sciences Center, Tucson, AZ 85273, USA. ronnie.fass@med.va.gov
D002637:Chest Pain / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D002986:Clinical Trials as Topic / Q000191:economics; D003362:Cost-Benefit Analysis; D003937:Diagnosis, Differential; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005069:Evaluation Studies as Topic; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D009853:Omeprazole / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors; D015203:Reproducibility of Results
D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D009853:Omeprazole