Predicting the efficacy of proton pump inhibitors in patients with non-erosive reflux disease before therapy using dual-channel 24-h esophageal pH monitoring
Journal of Gastroenterology and Hepatology,  Clinical Article

Shimatani T et al. – Pre–therapeutic pH monitoring in the lower and mid–esophagus is useful for predicting the efficacy of proton pump inhibitors (PPIs) in non–erosive reflux disease (NERD) patients.

Methods
  • Twenty-seven NERD patients who had experienced heartburn more than once a week within the previous month were enrolled.
  • Intraesophageal pH before therapy was measured simultaneously at 5 and 15 cm above the esophagogastric junction (EGJ) for 24 h.
  • The PPI rabeprazole was administered at a dose of 10 mg once daily for 4 weeks.
  • In the event that heartburn was not relieved, the dose was increased to 10 mg twice daily for an additional 2 weeks, and again to 20 mg twice daily for another 2 weeks.

Results
  • Univariate analysis demonstrated no significant associations between any reflux- or symptom-related parameters at either site and complete heartburn relief after 4 weeks, or cumulative complete heartburn relief after 8 weeks.
  • However, post-hoc analysis demonstrated more satisfactory heartburn relief after 4 weeks in patients with a high symptom index compared with those with a low symptom index, at 5 cm above the EGJ (P= 0.009).
  • Cumulative satisfactory heartburn relief after 8 weeks was also greater in patients with a high total number of acid reflux episodes compared with those with a low total number of episodes, at 15 cm above the EGJ (P= 0.037).

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