Psychosocial distress and quality of life impairment are associated with symptom severity in PPI non-responders with normal impedance-pH profiles

The American Journal of Gastroenterology | September 13, 2017

Yadlapati R, et al. - The clinicians identified factors correlated with symptom perception among proton pump inhibitor (PPI) non-responder phenotypes. Among PPI non-responders with normal impedance-pH, perceptions of reflux symptoms were associated with psychosocial distress, reduced quality of life (QOL), and sensation of dysphagia. Patient-reported symptom severity was correlated with physiological differences among PPI refractory gastroesophageal reflux disease (GERD) patients, as opposed to psychosocial factors.


  • From September 2014 to January 2017, the clinicians performed this prospective observational cohort study at a single academic medical center.
  • They included PPI non-responders who underwent 24-h impedance-pH monitoring and completed a questionnaire set measuring patient-reported symptom severity, quality of life (QOL), and psychosocial distress.
  • Based on impedance-pH results, participants were separated into cohorts:
    • On PPI: -acid exposure time (AET)/-symptom–reflux association (SRA), +AET, and -AET/+SRA
    • Off PPI: functional (-AET/-SRA), gastroesophageal reflux disease (GERD) (+AET), and reflux hypersensitivity (RHS) (-AET/+SRA).
  • Abnormal GERD symptom severity defined by GerdQ≥8 was the primary outcome.


  • The clinicians included 192 participants.
  • They performed impedance-pH on PPI on 125: 72 (58%) -AET/-SRA, 42 (34%) +AET, and 11 (9%) -AET/+SRA.
  • Factors associated with GerdQ≥8 among the -AET/-SRA group were younger age, higher dysphagia scores, QOL impairment, and higher brief symptom index.
  • Higher number of reflux-associated symptoms and lower distal contractile integral was associated with GerdQ≥8 among the +AET group.
  • They performed impedance-pH off PPI on 67 participants: 39 (58%) functional, 16 (24%) GERD, and 12 (18%) RHS.
  • Higher QOL impairment and dysphagia scores were seen with GerdQ≥8 among the functional group.

Read the full article on The American Journal of Gastroenterology