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, 04/19/2012

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.

• 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.

• 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).