Ambulatory 24-hour pH–impedance monitoring can be used to assess the relationship of persistent symptoms and reflux episodes, despite proton pump inhibitor (PPI) therapy.
Using this technique, Dr Nikos Viazis and colleagues from Greece identified patients with hypersensitive esophagus, and evaluated the effect of selective serotonin reuptake inhibitors (SSRIs) on their symptoms.
Patients with normal endoscopy and typical reflux symptoms, despite PPI therapy twice daily, underwent 24-hour pH–impedance monitoring.
Distal esophageal acid exposure was measured, and reflux episodes were classified into acid or non-acid.
A positive symptom index was declared if at least half of the symptom events were preceded by reflux episodes.
|87% of patients recorded symptoms during the study day |
|American Journal of Gastroenterology|
The research team classified patients with a normal distal esophageal acid exposure time, but with a positive SI as having hypersensitive esophagus.
The patients were randomized to receive citalopram 20 mg or placebo once daily for 6 months.
The researchers reported that a total of 252 patients underwent 24-hour pH–impedance monitoring.
The team reported that 87% of patients recorded symptoms during the study day, while 48% of those had a positive symptom index.
Among those patients, 71% had normal distal esophageal acid exposure time and were randomized to receive citalopram 20 mg or placebo.
At the end of the follow-up period, the researchers found that 39% of patients of group 1, and 67% of patients of group 2 continued to report reflux symptoms.
Dr Viazis' team concludes, "Treatment with SSRIs is effective in a select group of patients with hypersensitive esophagus."