Up to 50% of patients with reflux symptoms do not manifest a satisfactory symptom response to proton pump inhibitor therapy.
Dr Rena Yadlapati and colleagues from Aurora, Colorado, USA identified factors associated with symptom perception among proton pump inhibitor non-responder phenotypes.
The team performed a prospective observational cohort study from 2014 to 2017 at a single academic medical center and included proton pump inhibitor non-responders.
The patients underwent 24-h impedance-pH monitoring and completed a questionnaire set measuring patient-reported symptom severity, quality of life and psychosocial distress.
|Among the functional group, the team noted a higher quality of life impairment|
|American Journal of Gastroenterology|
Participants were separated into cohorts based on impedance-pH results: on proton pump inhibitor: - acid exposure time/−symptom–reflux association, +acid exposure time and −acid exposure time/+symptom–reflux association; off proton pump inhibitor: functional gastroesophageal reflux disease and reflux hypersensitivity.
The team's primary outcome was abnormal gastroesophageal reflux disease symptom severity defined by GerdQ≥8.
The researchers evaluated 192 participants.
The team reported that impedance-pH on proton pump inhibitor was performed on 125: 72 −acid exposure time/−symptom–reflux association, 42 +acid exposure time, and 11 −acid exposure time/+symptom–reflux association.
Among the −acid exposure time/−symptom–reflux association group, younger age, higher dysphagia scores, quality of life impairment, and higher brief symptom index were associated with GerdQ≥8.
The researchers observed that among the +acid exposure time group, higher number of reflux-associated symptoms and lower distal contractile integral was associated with GerdQ≥8.
Impedance-pH off proton pump inhibitor was performed on 67 participants: 39 functional, 16 gastroesophageal reflux disease and 12 reflux hypersensitivity.
Among the functional group, the team noted a higher quality of life impairment and dysphagia scores with GerdQ≥8.
Dr Yadlapati's team concludes: "Perceptions of reflux symptoms are associated with psychosocial distress, reduced quality of life and sensation of dysphagia among proton pump inhibitor non-responders with normal impedance-pH."
"Among proton pump inhibitor refractory gastroesophageal reflux disease patients, patient-reported symptom severity is associated with physiological differences, as
opposed to psychosocial factors."