title: Specific dyspeptic symptoms are associated with poor response to therapy in patients with gastroesophageal reflux disease.
abstract: BACKGROUND
  In patients with gastroesophageal reflux disease (GORD), co-existence of functional dyspepsia (FD) is known to be associated with poor response to proton pump inhibitors (PPIs), but the contribution of specific dyspepsia symptoms has not yet been systematically investigated.
  
  
  OBJECTIVE
  We aimed to characterize the impact of dyspepsia symptoms on response to PPIs in patients with GORD.
  
  
  METHODS
  The enrolled subjects were consecutive patients with a diagnosis of GORD. All patients underwent a 24 hour pH-impedance test, while on PPI therapy. Patients were divided into two groups, refractory and responders, according to the persistence of GORD symptoms. A standardized questionnaire for FD was also administered to assess presence of dyspepsia symptoms.
  
  
  RESULTS
  In the subgroup of refractory patients FD was more prevalent than in responders, with post-prandial fullness, nausea, vomiting, early satiation and epigastric pain being significantly prevalent in refractory GORD patients. In the multivariate analysis only early satiation and vomiting were significantly associated with poor response to PPIs.
  
  
  CONCLUSIONS
  Co-existence of FD is associated with refractory GORD. We showed that only early satiation and vomiting are risk factors for poor response to therapy with PPIs. Our findings suggest that symptoms of early satiation and vomiting would help to identify the subset of PPI-refractory GORD patients.
authors.affiliation: Federico II University of Naples, Naples, Italy.
authors.forename: A
authors.initials: A
authors.lastname: D'Alessandro
authors.affiliation: Federico II University of Naples, Naples, Italy.
authors.forename: F P
authors.initials: FP
authors.lastname: Zito
authors.affiliation: Federico II University of Naples, Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Pesce
authors.affiliation: Federico II University of Naples, Naples, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Andreozzi
authors.affiliation: Federico II University of Naples, Naples, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Efficie
authors.affiliation: Federico II University of Naples, Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Cargiolli
authors.affiliation: Federico II University of Naples, Naples, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Maione
authors.affiliation: Federico II University of Naples, Naples, Italy.
authors.forename: G D
authors.initials: GD
authors.lastname: De Palma
authors.affiliation: Federico II University of Naples, Naples, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Cuomo
authors.affiliation: Federico II University of Naples, Naples, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Sarnelli
keywords: Refractory GERD; early satiation; functional dyspepsia; pH–impedance monitoring; proton pump inhibitors; vomiting