Response to proton-pump inhibitors (PPIs) generally supports a diagnosis of gastroesophageal reflux disease (GERD). However, the accuracy of this diagnostic strategy is not been well established.
In this study, doctors from the Netherlands and the United States performed a meta-analysis of the published literature.
The team identified English-language studies from the Cochrane Clinical Trial Register and MEDLINE from 1980 to 2003.
They included studies where the clinical response to a short course of normal- or high-dose PPI therapy could be compared with objective measures of GERD.
|Sensitivity and specificity were 0.78 and 0.54, respectively.|
|Annals of Internal Medicine|
Data extracted included patient characteristics, study design, setting, specific type and dose of medication, duration of treatment, and definitions of outcomes.
The doctors determined the sensitivity and specificity by comparing a clinical response to PPIs with objective measures for GERD.
Overall, 15 studies met the team's inclusion criteria and provided sufficient data.
If 24-hour pH monitoring was used as the reference standard, the team found that the positive likelihood ratio ranged from 1.63 to 1.87. They also found that combined estimates of sensitivity and specificity were 0.78 and 0.54, respectively.
The doctors found that the sensitivity and specificity values were lower if other GERD reference standards were used.
Dr Mattijs Numans and colleagues concluded, "Successful short-term treatment with a PPI in patients suspected of having GERD does not confidently establish the diagnosis when GERD is defined by currently accepted reference standards".