Ambulatory Reflux Monitoring Guides Proton Pump Inhibitor Discontinuation in Patients With Gastroesophageal Reflux Symptoms: A Clinical Trial
| Autor: | C. Prakash Gyawali, Melina Masihi, Rena Yadlapati, Joseph Triggs, Leila Kia, Michael F. Vaezi, Peter J. Kahrilas, Anand Jain, John E. Pandolfino, Alexander M. Kaizer, Dustin A. Carlson, Billy D. Nix |
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| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Adult Male medicine.medical_specialty Esophageal pH Monitoring medicine.drug_class Proton-pump inhibitor Monitoring Ambulatory Chest pain Drug Administration Schedule 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Hepatology business.industry Gastroenterology Reflux Heartburn Proton Pump Inhibitors Middle Aged medicine.disease Discontinuation Clinical trial 030104 developmental biology Treatment Outcome GERD Gastroesophageal Reflux 030211 gastroenterology & hepatology Female medicine.symptom business Esophagitis |
| Zdroj: | Gastroenterology. 160(1) |
| ISSN: | 1528-0012 |
| Popis: | Background and Aims Proton pump inhibitor (PPI) therapy fails to provide adequate symptom control in up to 50% of patients with gastroesophageal reflux symptoms. Although a proportion do not require ongoing PPI therapy, a diagnostic approach to identify candidates appropriate for PPI cessation is not available. This study aimed to examine the clinical utility of prolonged wireless reflux monitoring to predict the ability to discontinue PPIs. Methods This double-blinded clinical trial performed over 3 years at 2 centers enrolled adults with troublesome esophageal symptoms of heartburn, regurgitation, and/or chest pain and inadequate PPI response. Participants underwent prolonged wireless reflux monitoring (off PPIs for ≥7 days) and a 3-week PPI cessation intervention. Primary outcome was tolerance of PPI cessation (discontinued or resumed PPIs). Symptom burden was quantified using the Reflux Symptom Questionnaire electronic Diary (RESQ-eD). Results Of 128 enrolled, 100 participants met inclusion criteria (mean age, 48.6 years; 41 men). Thirty-four participants (34%) discontinued PPIs. The strongest predictor of PPI discontinuation was number of days with acid exposure time (AET) > 4.0% (odds ratio, 1.82; P 4.0% had a 10 times increased odds of discontinuing PPI than participants with 4 days of AET > 4.0%. Reduction in symptom burden was greater among the discontinued versus resumed PPI group (RESQ-eD, –43.7% vs –5.3%; P = .04). Conclusions Among patients with typical reflux symptoms, inadequate PPI response, and absence of severe esophagitis, acid exposure on reflux monitoring predicted the ability to discontinue PPIs without symptom escalation. Upfront reflux monitoring off acid suppression can limit unnecessary PPI use and guide personalized management. (ClinicalTrials.gov, Number: NCT03202537) |
| Databáze: | OpenAIRE |
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