Diagnostic value of the PPI test for detection of GERD in Korean patients and factors associated with PPI responsiveness.
OBJECTIVE
Data supporting the use of the proton pump inhibitor (PPI) test as a diagnostic test of gastroesophageal reflux disease (GERD) in Asia are lacking. The aims of this study were to evaluate the diagnostic characteristics of the PPI test and factors associated with responsiveness to PPIs.


METHODS
The PPI test was evaluated using lansoprazole (30 mg bid) for two weeks. All patients underwent endoscopy after symptom assessment. Patients without erosive esophagitis (ERD) underwent 48 h esophageal Bravo pH monitoring. Subjects were considered to be responsive to PPIs if they reported a > 50% reduction in reflux symptom score.


RESULTS
Seventy-three patients (M:F = 40:37, 47 +/- 13 years) were enrolled. We identified 46 patients with ERD, 18 patients with nonerosive reflux disease (NERD) and 9 patients without GERD. The PPI response rate was higher in patients with GERD than in patients without GERD (49/64, 77% vs. 4/9, 44%; p < 0.05). The sensitivity, specificity, and positive and negative predictive values were 77%, 56%, 92% and 25%, respectively. The PPI responsiveness was 80% (37/46) in the ERD group and 67% (12/18) in the NERD group. PPI response was not affected by age, sex, Helicobacter pylori, the psychological characteristics or cytochrome P2C genotypes. ERD and symptom-reflux association were the factors affecting PPI responsiveness.


CONCLUSIONS
The PPI test was modestly sensitive and specific for diagnosing GERD. However, it would be useful for discriminating patients with ERD. In the NERD group, patients with positive symptom-reflux association would be most benefit from PPI treatment.
Cho
Yu Kyung
YK
Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea.
Choi
Myung-Gyu
MG
Lim
Chul Hyun
CH
Nam
Kwan Woo
KW
Chang
Jae Hyuck
JH
Park
Jae Myung
JM
Lee
In Seok
IS
Kim
Sang Woo
SW
Choi
Kyu Yong
KY
Chung
In-Sik
IS
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D016009:Chi-Square Distribution; D050782:Esophageal pH Monitoring; D004945:Esophagoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006801:Humans; D007723:Korea; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D011237:Predictive Value of Tests; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D054328:Proton Pump Inhibitors; D064747:Lansoprazole