title: Gastroesophageal reflux disease management according to contemporary international guidelines: a translational study.
abstract: OBJECTIVE
  To test the Genval recommendations and the usefulness of a short trial of proton pump inhibitor (PPI) in the initial management and maintenance treatment of gastroesophageal reflux disease (GERD) patients.
  
  
  METHODS
  Five hundred and seventy seven patients with heartburn were recruited. After completing a psychometric tool to assess quality of life (PGWBI) and a previously validated GERD symptom questionnaire (QUID), patients were grouped into those with esophagitis (EE, n = 306) or without mucosal damage (NERD, n = 271) according to endoscopy results. The study started with a 2-wk period of high dose omeprazole (omeprazole test); patients responding to this PPI test entered an acute phase (3 mo) of treatment with any PPI at the standard dose. Finally, those patients with a favorable response to the standard PPI dose were maintained on a half PPI dose for a further 3-mo period.
  
  
  RESULTS
  The test was positive in 519 (89.9%) patients, with a greater response in EE patients (96.4%) compared with NERD patients (82.6%) (P = 0.011). Both the percentage of completely asymptomatic patients, at 3 and 6 mo, and the reduction in heartburn intensity were significantly higher in the EE compared with NERD patients (P < 0.01). Finally, the mean PGWBI score was significantly decreased before and increased after therapy in both subgroups when compared with the mean value in a reference Italian population.
  
  
  CONCLUSIONS
  Our study confirms the validity of the Genval guidelines in the management of GERD patients. In addition, we observed that the overall response to PPI therapy is lower in NERD compared to EE patients.
authors: Division of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, 74-20157 Milano, Italy. fabio.pace@unimi.it
authors: Fabio
authors: F
authors: Pace
authors: Gabriele
authors: G
authors: Riegler
authors: Annalisa
authors: A
authors: de Leone
authors: Patrizia
authors: P
authors: Dominici
authors: Enzo
authors: E
authors: Grossi
mesh_terms: D000328:Adult; D004941:Esophagitis / Q000209:etiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000473:pathology / Q000628:therapy*; D017408:Guidelines as Topic; D006356:Heartburn / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D057170:Translational Research, Biomedical; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors; D009853:Omeprazole