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Acid-based reflux parameters better predict PPI therapy response
Acid-based reflux parameters are better predictors of symptom improvement in response to proton pump inhibitor therapy compared to impedance-based nonacid-reflux parameters, according to new research.
Over a 5-year study period, 128 subjects (mean age of 53.3 years, 66.4% female; typical symptoms 57%, 53.9% tested on anti-secretory therapy) completed questionnaires after receiving pH-impedance testing and subsequent therapy for reflux symptoms.
C. Prakash Gyawali
The following acid-reflux parameters were extracted from the data:
- Acid-exposure time, AET
- Symptom association by Ghillebert probability estimate, GPE
- Symptom index, SI
The following impedance-based parameters were extracted from the data:
- Reflux exposure time, RET
- Number of reflux events
- GPE
- SI with impedance
Average global symptom severity (GSS) on follow-up (3.35±0.14 years later) declined by 45%, with 42.3 patients reporting ≥50% GSS improvement. Using univariate analysis, total AET, AET≥4% and GPE for reflux events predicted both linear and ≥50% improvement, but reflux RET was not predictive.
Only AET (P=.003) and GPE for all reflux events (P=.029) predicted GSS improvement.
“Reported symptoms and number of acid-reflex events were significantly higher when testing was performed off anti-secretory therapy,” the study authors wrote. “Our findings support conducting pH-impedance studies off [proton pump inhibitor therapy] to maximize clinical utility in predicting outcome.”
Disclosure: Study authors reported no relevant financial disclosures.