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Clinical trial: persistent gastro‐oesophageal reflux symptoms despite standard therapy with proton pump inhibitors – a follow‐up study of intraluminal‐impedance guided therapy
Author(s) -
BECKER V.,
BAJBOUJ M.,
WALLER K.,
SCHMID R. M.,
MEINING A.
Publication year - 2007
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2007.03529.x
Subject(s) - medicine , reflux , gerd , gastroenterology , pathological , proton pump inhibitor , refractory (planetary science) , gastro , disease , physics , astrobiology
Summary Background Persistent gastro‐oesophageal reflux disease (GERD), despite proton pump inhibitor (PPI) therapy, is a common problem. Combined pH/impedance monitoring (pH/MII) enables detection of reflux episodes. Aim To identify patients with objective episodes of persistent reflux and second, to evaluate the effect of modified therapy based on the results of pH/MII. Methods In all, 143 patients were examined with pH/MII because of GERD‐symptoms resistant to PPI‐therapy. Patients with pathological pH/MII (group 1) and with normal results (group 2) were identified. Therapy modifications were evaluated after a minimum follow‐up of 3 months. Results In 56 of 143 (39.1%) patients, pathological findings in pH/MII were identified. Therapy was escalated in 33/52 patients (group 1) and in 30/71 patients (group 2). Escalating therapy led to symptomatic relief in 90.9% of the patients in group 1 and 43.3% of the patients in group 2 ( P < 0.001). Conclusions GERD symptoms refractory to PPI‐therapy could be objectively identified with pH/MII in almost 40% of all patients. Furthermore, escalating anti‐reflux therapy if pH/MII was pathological is associated with a significantly higher rate of successful treatment compared to the patients with normal findings. Therefore, pH/MII facilitates a more focussed therapeutical approach to patients with PPI‐resistant GERD.