Up to 40% of patients with non-erosive reflux disease fail to respond to proton pump inhibitor therapy.
Professor Nicholas Talley and colleagues from Minnesota determined useful prognostic factors for response to, and suppression in non-erosive reflux disease.
The team of doctors conducted a pooled analysis from 3 multicenter, double-blind trials.
The patients had a normal endoscopy and heartburn for 4 days or more during the 7 days prior to the start of each treatment.
| Response on days 5 to 7 gave an 85% probability of complete resolution of heartburn|
|Alimentary Pharmacology & Therapeutics|
Patients received omeprazole 20 mg, esomeprazole 20 mg or esomeprazole 40 mg/day for 4 weeks.
The doctors defined complete resolution of heartburn as no heartburn during the last week.
Of 2458 patients included, complete heartburn resolution was achieved in 63% at the end of 4 weeks treatment.
The doctors found that response on days 5 to 7 provided an 85% probability of complete resolution of heartburn at 4 weeks.
The probability of complete heartburn resolution at 4 weeks in those with moderate to severe symptoms on days 5 to 7 was 22%.
Sensitivity and specificity of no heartburn on days 5 to 7 was 55% and 83%, respectively.
The team observed that patient demographics, duration of symptoms, medications used, other symptoms, and body mass index were not predictors.
Professor Talley's team concludes, “Assessment of heartburn resolution during the first week of therapy was the best predictor of treatment success at 4 weeks in non-erosive reflux disease, but was suboptimal as a test.”