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Prevalence and clinical characteristics of refractoriness to optimal proton pump inhibitor therapy in non-erosive reflux disease.
Aliment Pharmacol Ther. 2018 11; 48(10):1074-1081.AP

Abstract

BACKGROUND

The real size of the gastro-oesophageal reflux disease (GERD) population not responding to proton pump inhibitor (PPI) therapy has still not been fully elucidated. Causes of PPI refractoriness include incorrect diagnosis and lack of adherence to therapy, in terms of incorrect dosage and timing.

AIMS

To evaluate the prevalence of refractoriness to optimal PPI therapy and the contribution of non-erosive reflux disease (NERD), reflux hypersensitivity, and functional heartburn, to PPI refractoriness. The association of functional GI symptoms in non-responders was evaluated.

METHODS

Frequency and severity of GERD symptoms (heartburn, regurgitation, chest pain), dysphagia, belching, epigastric pain, postprandial distress, irritable bowel syndrome (IBS), globus, and ear nose and throat (ENT) symptoms were evaluated in patients previously classified as non-responders. Patients with at least one of the oesophageal symptoms with a frequency ≥3 /week were treated with esomeprazole 40 mg once daily for 8 weeks and then re-evaluated. Non-responders (patients with oesophageal symptoms ≥3 times per week) underwent 24 hour multichannel intraluminal impedance-pH monitoring.

RESULTS

Of 573 consecutive patients, 92 with oesophageal symptoms and classified as PPI-refractory underwent the esomeprazole trial; 60 did not respond. IBS, epigastric pain, and post-prandial distress episodes were associated with a poor response on multivariate analysis. NERD, reflux hypersensitivity, and functional heartburn patients constituted 32%, 42%, and 26%, respectively of the PPI-refractory group.

CONCLUSIONS

True refractoriness in patients with GERD symptoms attending a secondary care setting is lower than previously reported. Following a careful history and optimal PPI dosing, the rate of refractoriness was 20%. True NERD constitutes only a third of the PPI-refractory group.

Authors+Show Affiliations

Digestive Disease Unit, Campus Bio Medico University, Rome, Italy.Digestive Disease Unit, Campus Bio Medico University, Rome, Italy.Gastroenterology Unit, University of Genoa, Genova, Italy.Section of Internal Medicine, Department of Medicine and Aging Sciences and Center for Excellence on Ageing (Ce.S.I.Met), "G. D'Annunzio" University and Foundation, Chieti, Italy.Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan, Milan, Italy.Section of Internal Medicine, Department of Medicine and Aging Sciences and Center for Excellence on Ageing (Ce.S.I.Met), "G. D'Annunzio" University and Foundation, Chieti, Italy.Digestive Disease Unit, Campus Bio Medico University, Rome, Italy.Gastroenterology Unit, University of Genoa, Genova, Italy.Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan, Milan, Italy.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

30294924

Citation

Ribolsi, Mentore, et al. "Prevalence and Clinical Characteristics of Refractoriness to Optimal Proton Pump Inhibitor Therapy in Non-erosive Reflux Disease." Alimentary Pharmacology & Therapeutics, vol. 48, no. 10, 2018, pp. 1074-1081.
Ribolsi M, Cicala M, Zentilin P, et al. Prevalence and clinical characteristics of refractoriness to optimal proton pump inhibitor therapy in non-erosive reflux disease. Aliment Pharmacol Ther. 2018;48(10):1074-1081.
Ribolsi, M., Cicala, M., Zentilin, P., Neri, M., Mauro, A., Efthymakis, K., Petitti, T., Savarino, V., & Penagini, R. (2018). Prevalence and clinical characteristics of refractoriness to optimal proton pump inhibitor therapy in non-erosive reflux disease. Alimentary Pharmacology & Therapeutics, 48(10), 1074-1081. https://doi.org/10.1111/apt.14986
Ribolsi M, et al. Prevalence and Clinical Characteristics of Refractoriness to Optimal Proton Pump Inhibitor Therapy in Non-erosive Reflux Disease. Aliment Pharmacol Ther. 2018;48(10):1074-1081. PubMed PMID: 30294924.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence and clinical characteristics of refractoriness to optimal proton pump inhibitor therapy in non-erosive reflux disease. AU - Ribolsi,Mentore, AU - Cicala,Michele, AU - Zentilin,Patrizia, AU - Neri,Matteo, AU - Mauro,Aurelio, AU - Efthymakis,Konstantinos, AU - Petitti,Tommasangelo, AU - Savarino,Vincenzo, AU - Penagini,Roberto, Y1 - 2018/10/07/ PY - 2018/05/24/received PY - 2018/06/18/revised PY - 2018/08/22/accepted PY - 2018/10/9/pubmed PY - 2019/10/11/medline PY - 2018/10/9/entrez SP - 1074 EP - 1081 JF - Alimentary pharmacology & therapeutics JO - Aliment. Pharmacol. Ther. VL - 48 IS - 10 N2 - BACKGROUND: The real size of the gastro-oesophageal reflux disease (GERD) population not responding to proton pump inhibitor (PPI) therapy has still not been fully elucidated. Causes of PPI refractoriness include incorrect diagnosis and lack of adherence to therapy, in terms of incorrect dosage and timing. AIMS: To evaluate the prevalence of refractoriness to optimal PPI therapy and the contribution of non-erosive reflux disease (NERD), reflux hypersensitivity, and functional heartburn, to PPI refractoriness. The association of functional GI symptoms in non-responders was evaluated. METHODS: Frequency and severity of GERD symptoms (heartburn, regurgitation, chest pain), dysphagia, belching, epigastric pain, postprandial distress, irritable bowel syndrome (IBS), globus, and ear nose and throat (ENT) symptoms were evaluated in patients previously classified as non-responders. Patients with at least one of the oesophageal symptoms with a frequency ≥3 /week were treated with esomeprazole 40 mg once daily for 8 weeks and then re-evaluated. Non-responders (patients with oesophageal symptoms ≥3 times per week) underwent 24 hour multichannel intraluminal impedance-pH monitoring. RESULTS: Of 573 consecutive patients, 92 with oesophageal symptoms and classified as PPI-refractory underwent the esomeprazole trial; 60 did not respond. IBS, epigastric pain, and post-prandial distress episodes were associated with a poor response on multivariate analysis. NERD, reflux hypersensitivity, and functional heartburn patients constituted 32%, 42%, and 26%, respectively of the PPI-refractory group. CONCLUSIONS: True refractoriness in patients with GERD symptoms attending a secondary care setting is lower than previously reported. Following a careful history and optimal PPI dosing, the rate of refractoriness was 20%. True NERD constitutes only a third of the PPI-refractory group. SN - 1365-2036 UR - https://www.unboundmedicine.com/medline/citation/30294924/Prevalence_and_clinical_characteristics_of_refractoriness_to_optimal_proton_pump_inhibitor_therapy_in_non_erosive_reflux_disease_ L2 - https://doi.org/10.1111/apt.14986 DB - PRIME DP - Unbound Medicine ER -