title: Survey of findings in patients having persistent heartburn on proton pump inhibitor therapy.
abstract: In patients with refractory heartburn while on proton pump inhibitor (PPI) therapy, changing drugs or increasing treatment to a twice a day (b.i.d.) dose has become a common practice. This study aims to study patients with persistent heartburn while on PPI therapy and to determine if persistent symptom indicates the need for more aggressive or different therapy. A retrospective review of impedance-pH tracings on PPI therapy (q.d. or b.i.d.) for patients with persistent heartburn was performed. DeMeester score, impedance, and symptom sensitive index (SSI) were used as indices. Statistical analyses were performed using chi-squared test with Yates correction and paired t-test. One hundred consecutive patients, (female 50%, male 50%, mean age 54 [range 16-83] years) were studied on q.d. (n = 45) or b.i.d. PPI (n = 55). Only 20% of the patients had abnormal DeMeester score; 41% had an abnormal impedance score and 56% had abnormal SSI; 29% had all indices normal. There was no difference between patients taking q.d. versus b.i.d. PPI for abnormal DeMeester score (22 vs. 18%), impedance (38 vs. 44%) and SSI (53 vs. 58%); P = 0.80, 0.69, and 0.77, respectively. In 56 patients with positive SSI, symptoms were due to acid reflux in 8 (14%) patients, nonacid reflux in 31 (55%) patients, and combined acid and nonacid reflux in 17 (30%) patients. Patients with persistent heartburn on PPI therapy show a variety of disorders: (i) acid reflux (20%); (ii) nonacid reflux (26%); (iii) positive SSI (56%); (iv) all normal indices (29%). These studies indicate that persistent heartburn on PPI therapy is a complex problem that may not respond to simply increasing acid inhibition.
authors.affiliation: Division of Internal Medicine, Abington Memorial Hospital, Abington, Pennsylvania, USA.
authors.forename: R
authors.initials: R
authors.lastname: Mandaliya
authors.affiliation: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: DiMarino
authors.affiliation: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: S
authors.initials: S
authors.lastname: Cohen
mesh_terms: D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance; D017097:Electric Impedance; D050782:Esophageal pH Monitoring / Q000379:methods; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D006356:Heartburn / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000494:pharmacology; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D063189:Symptom Assessment
chemical_list: D054328:Proton Pump Inhibitors
keywords: DeMeester score; gastroesophageal reflux disease; heartburn; impedance; proton pump inhibitor; symptom sensitivity index