Introduction
The evaluation of gastroesophageal reflux disease (GERD) often includes the analysis of symptom-reflux correlation metrics such as the Symptom Index (SI) and Symptom Association Probability (SAP). These tools provide critical insights into the temporal relationship between reflux episodes and symptom perception, aiding in the identification of patients most likely to benefit from a tailored PPI treatment.
Aims & Methods
The aim of this study was to evaluate a continuous series of patients responsive to PPI treatment and differentiate those with GERD and those without. a series of consecutive patients with NERD o grade A esophagitis underwent monitoring tests for esophageal pathophysiology (MIIpH 24h).
All patients were evaluated for epidemiological and anthropometric characteristics and clinical presentation (GERDQ). According to the aim of this study we decided to enroll only patients that were full responders to the treatment with PPIs longer that 3 months. Treatment response was evaluated with (VAS). Evaluated pathophysiological parameters: acid exposure time (AET), reflux number, mean nocturnal baseline impedance (MNBI) and SI and SAP were calculated. Patients were divided in proven GERD or negative GERD according to the Lyon 2.0 Consensus thresholds.
Results
We enrolled throughout the last six months 83 patients (57 female) with an adequate heartburn relief with a standard therapy with PPIs. Patients were divided in proven 26 GERD (16 F, mean age 58.6 yr, BMI 27.9) and 57 Negative GERD (41 F, mean age 53.2 yr, BMI 24.5). Heartburn relief (VAS) was similar in the two different groups (p=NS) and similarly the duration of the treatment with the full dose of PPIs. The parameters able to distinguish GERD from non-GERD were: AET, Reflux events number and MNBI (p<0.01) from pathophysiological point of view and higher BMI and male sex from epidemiological characteristics (p<0.001). For details see Table 1.
| True GERD (26)
| Negative GERD (57)
| p
|
| Age | 58.6±12.7
| 53.2±14.4
| 0.104
|
| Female | 16/26 | 41/75 | 0.001
|
Heartburn Improvement (VAS)
| 80.8±14.9
| 75.6±15.4
| 0.153
|
Treatment duration (months)
| 6.1±2.4
| 5.9±2.9
| 0.447
|
GERDQ
| 9±2.1
| 9.1±1.9
| 0.831
|
| AET | 11.6±6.5
| 1.7±1.5
| <0.0001
|
Reflux events
| 49.3±23.3
| 24.7±11.3
| <0.0001
|
SI/SAP positive
| 2/26
| 5/57
| >0.99 |
MNBI
| 1169.7±515.2
| 3342.4±978.2
| <0.0001
|
Conclusion
Only MIIpH variables are able to distinguish patients with proven GERD from those with no GERD.
References
Gyawali CP, Yadlapati R, Fass R, Katzka D, Pandolfino J, Savarino E, Sifrim D, Spechler S, Zerbib F, Fox MR, Bhatia S, de Bortoli N, Cho YK, Cisternas D, Chen CL, Cock C, Hani A, Remes Troche JM, Xiao Y, Vaezi MF, Roman S. Updates to the modern diagnosis of GERD: Lyon consensus 2.0. GUT 2024 Jan 5;73(2):361-371.
Disclosure
Conference Speech: Reckitt Benckiser; Malesci; Dr Falk, PharmaLine, AlfaSigma, Sanofi-Genzyme.
Advisory Board: Dr Falk; Astra Zeneca; Sanofi Genzyme, AlfaSigma
Research grant: Dr Falk; Sanofi Genzyme