title: Clinical, but not oesophageal pH-impedance, profiles predict response to proton pump inhibitors in gastro-oesophageal reflux disease.
abstract: OBJECTIVE
  Approximately 30% of patients with gastro-oesophageal reflux disease (GORD) do not achieve adequate symptom control with proton pump inhibitors (PPIs). The aim of this study was to determine whether any symptom profile or reflux pattern was associated with refractoriness to PPI therapy.
  
  
  METHODS
  Patients with typical GORD symptoms (heartburn and/or regurgitation) were included and had 24 h pH-impedance monitoring off therapy. Patients were considered to be responders if they had fewer than 2 days of mild symptoms per week while receiving a standard or double dose of PPI treatment for at least 4 weeks. Both clinical and reflux parameters were taken into account for multivariate analysis (logistic regression).
  
  
  RESULTS
  One hundred patients were included (median age 50 years, 42 male), 43 responders and 57 non-responders. Overall, multivariate analysis showed that the factors associated with the absence of response were absence of oesophagitis (p=0.050), body mass index (BMI) ≤25 kg/m(2) (p=0.002) and functional dyspepsia (FD) (p=0.001). In patients who reported symptoms during the recording (n=85), the factors associated with PPI failure were BMI ≤25 kg/m(2) (p=0.004), FD (p=0.009) and irritable bowel syndrome (p=0.045). In patients with documented GORD (n=67), the factors associated with PPI failure were absence of oesophagitis (p=0.040), FD (p=0.003), irritable bowel syndrome (p=0.012) and BMI ≤25 kg/m(2) (p=0.029).
  
  
  CONCLUSIONS
  No reflux pattern demonstrated by 24 h pH-impedance monitoring is associated with response to PPIs in patients with GORD symptoms. In contrast, absence of oesophagitis, presence of functional digestive disorders and BMI ≤25 kg/m(2) are strongly associated with PPI failure.
authors: Gastroenterology and Hepatology Department, CHU Bordeaux, Saint André Hospital, Bordeaux, Bordeaux, France. frank.zerbib@chu-bordeaux.fr
authors: Frank
authors: F
authors: Zerbib
authors: Kafia
authors: K
authors: Belhocine
authors: Mireille
authors: M
authors: Simon
authors: Maylis
authors: M
authors: Capdepont
authors: François
authors: F
authors: Mion
authors: Stanislas
authors: S
authors: Bruley des Varannes
authors: Jean-Paul
authors: JP
authors: Galmiche
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D004415:Dyspepsia / Q000209:etiology; D050782:Esophageal pH Monitoring; D004942:Esophagitis, Peptic / Q000209:etiology; D004945:Esophagoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors