title: Positive predictors for gastroesophageal reflux disease and the therapeutic response to proton-pump inhibitors.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Valentin Becker, Stefan Grotz, Christoph Schlag, Simon Nennstiel, Analena Beitz, Roland M Schmid, Alexander Meining, Monther Bajbouj, II. Medizinische Klinik und Poliklinik, Technische Universität München, D-81675 Munich, Germany.
authors.forename: Valentin
authors.initials: V
authors.lastname: Becker
authors.affiliation: Valentin Becker, Stefan Grotz, Christoph Schlag, Simon Nennstiel, Analena Beitz, Roland M Schmid, Alexander Meining, Monther Bajbouj, II. Medizinische Klinik und Poliklinik, Technische Universität München, D-81675 Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Grotz
authors.affiliation: Valentin Becker, Stefan Grotz, Christoph Schlag, Simon Nennstiel, Analena Beitz, Roland M Schmid, Alexander Meining, Monther Bajbouj, II. Medizinische Klinik und Poliklinik, Technische Universität München, D-81675 Munich, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schlag
authors.affiliation: Valentin Becker, Stefan Grotz, Christoph Schlag, Simon Nennstiel, Analena Beitz, Roland M Schmid, Alexander Meining, Monther Bajbouj, II. Medizinische Klinik und Poliklinik, Technische Universität München, D-81675 Munich, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Nennstiel
authors.affiliation: Valentin Becker, Stefan Grotz, Christoph Schlag, Simon Nennstiel, Analena Beitz, Roland M Schmid, Alexander Meining, Monther Bajbouj, II. Medizinische Klinik und Poliklinik, Technische Universität München, D-81675 Munich, Germany.
authors.forename: Analena
authors.initials: A
authors.lastname: Beitz
authors.affiliation: Valentin Becker, Stefan Grotz, Christoph Schlag, Simon Nennstiel, Analena Beitz, Roland M Schmid, Alexander Meining, Monther Bajbouj, II. Medizinische Klinik und Poliklinik, Technische Universität München, D-81675 Munich, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Haller
authors.affiliation: Valentin Becker, Stefan Grotz, Christoph Schlag, Simon Nennstiel, Analena Beitz, Roland M Schmid, Alexander Meining, Monther Bajbouj, II. Medizinische Klinik und Poliklinik, Technische Universität München, D-81675 Munich, Germany.
authors.forename: Roland M
authors.initials: RM
authors.lastname: Schmid
authors.affiliation: Valentin Becker, Stefan Grotz, Christoph Schlag, Simon Nennstiel, Analena Beitz, Roland M Schmid, Alexander Meining, Monther Bajbouj, II. Medizinische Klinik und Poliklinik, Technische Universität München, D-81675 Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Meining
authors.affiliation: Valentin Becker, Stefan Grotz, Christoph Schlag, Simon Nennstiel, Analena Beitz, Roland M Schmid, Alexander Meining, Monther Bajbouj, II. Medizinische Klinik und Poliklinik, Technische Universität München, D-81675 Munich, Germany.
authors.forename: Monther
authors.initials: M
authors.lastname: Bajbouj
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000188:drug therapy*; D006356:Heartburn; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D000077402:Pantoprazole; D011237:Predictive Value of Tests; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012372:ROC Curve; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D054328:Proton Pump Inhibitors; D000077402:Pantoprazole
keywords: Follow-up; Gastroesophageal reflux; Gastroesophageal reflux disease; Impedance pH measurement; Non-erosive reflux disease; Proton pump inhibitor; Therapy
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