| Background:The incidence of gastroesophageal reflux disease (GERD) is increased in Asiancountries. But it is not attracted enough attention, and also causes a high rate ofmisdiagnosis. Proton pump inhibitor (PPI) is the first choice of treatment of GERD,but the symptoms are partial or complete existence in about10%-40%of patientswith GERD who receiving standard-dose or high-dose of PPI. In addition, suchpatients always fail to achieve symptom significantly control with prolong the periodof treatment. The long term use of PPI may also cause adverse effects, such asinterstitial nephritis, fracture, small intestinal bacterial overgrowth and so on.24-houresophageal multichannel intraluminal impedance-pH (MII-pH) monitoring is a newtechnique that can be used to detect all types of gastroesophageal reflux and to assessthe relationship between reflux and symptoms of patients. The technique is especiallyhelpful in the diagnosis of refractory GERD. Thus, if the effect of acid suppressioncan be predicted before the treatment, it may be very useful for us to guide theclinical therapy, save the expense of therapy and reduce drug adverse reaction.However, at the present, there are few reports in these kinds of researches.Objective:To investigate the predictors of response to acid suppression in GERD patients.Methods:During August2010to December2011, the patients with heartburn and/orregurgitation who presented at the gastroenterology outpatient clinic at the firstaffiliated hospital of Nanchang University were enrolled. Heartburn and/orregurgitation must be predominant symptom for at least6months, and≥2days ofmild symptoms or≥1day of moderate symptoms for last2weeks before enrolled.All the patients underwent upper endoscopy and24-hour MII-pH monitoring beforereceiving esomeprazole20mg Bid for8weeks. Patients were considered to beresponders if they had fewer than2days of mild symptoms during the week beforevisit. Reflux esophagitis (RE) were graded using the Los Angeles classification. Age ≥50was defined as older people. Body mass index (BMI)≥25Kg/m~2was defined asoverweight. Smoking was defined as who continuously smoked at least1year.Drinking was defined who drunk at least2times per week, regardless of drinkvolume for at least1year. Functional dyspepsia (FD) and irritable bowel syndrome(IBS) symptoms were diagnosed by Rome III classification. The hospital anxiety anddepression scale was used to diagnose whether patients had anxiety and/or depressionsymptoms. Gender, age, BMI, smoking, drinking, endoscopic manifestation, theseverity of symptom, GerdQ score, presence of FD symptoms, presence of IBSsymptoms, anxiety and depression symptoms, reflux parameters (pathological acidreflux, reflux symptom association analyses, reflux episodes) were taken into analysis,investigated their effect on the acid suppression therapy of GERD.Results:1. Totally204patients were collected,17cases were ineligible,15cases refusedto participate in this study,3cases were intolerance of exam,16cases had normal ofall exam. Finally, there were153patients enrolled, inculed11cases lost to follow-up,4cases discountied treamtment.2. Of the153eligible patients,75were male (49.0%) and78were female(51.0%) with mean age46.3±10.6years, age≥50were51(33.3%); mean BMI was22.7±3.4Kg/m2，BMI≥25kg/m~2was37(24.2%);17(11.1%) were smokers,22(14.4%) were drinkers;47(30.7%) were RE, the proportion of grade A was70.2%,the proportion of grade B was27.7%, the proportion of grade C was2.1%;88(57.5%)patients with chief complaint of heartburn and65(42.5%) with chief complaint ofregurgitation;67(43.8%) with chief complaint score≥6;75(49.0%) with GerdQscore≥8;70(45.8%) presence of FD symptoms alone,14(9.2%) presence of IBSsymptoms alone,16(10.5%) overlap with FD and IBS symptoms,69(45.1%)presence of anxiety symptoms,37(24.2%) presence of depression symptoms;68(44.4%) had pathological acid reflux (PAR);39(25.5%) had symptom index (SI)positive,31(20.3%) had symptom association probability (SAP) positive.3.95(62.1%) patients were responders, and58(37.9%) patients werenon-responders to acid suppression therapy, the univariate analysis of the factorsmentioned above, absence of RE (P=0.04), chief complaint score≥6(P=0.004), GerdQ score <8(P=0.03), presence of IBS symptoms alone (P=0.03), overlap withFD and IBS symptoms (P=0.007), anxiety symptoms (P=0.003), depressionsymptoms (P=0.002), absence of PAR (P=0.003), shorter bolus clearance time(P=0.009), shorter of the percentage of acid reflux time (P=0.003) may be the factorsassociated with failure of acid suppression; in multivariate logistic regression analysis,PAR (OR:4.11,95%CI:1.81-9.35, P=0.001) was effective predictor for acidsuppression success; presence of IBS symptoms alone (OR:0.15,95%CI:0.04-0.58,P=0.006), overlap with FD and IBS symptoms (OR:0.15,95%CI:0.04–0.50,P=0.002), depression symptoms (OR:0.30,95%CI:0.13-0.69, P=0.005) were thepredictors of acid suppression failure.Conclusion:1. Presence of IBS symptoms alone, overlap with FD and IBS symptoms, anddepression symptoms are the factors predicted the poorer acid suppression therapy ofGERD, while GERD patients with PAR have better effectiveness of acid suppressiontherapy.2. Clinical symptoms and pH monitoring alone can effectively predict theefficacy of acid suppression therapy of GERD patients before treatment.3. The role of impedance in predicting acid suppression therapy needs to befurther explored. |
PDF Full Text Request