The Effects of Advanced Diagnostic Methods and Disease Phenotypes on the Response to PPI in Patients with Gastroesophageal Reflux Disease

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AIMS: The purpose of this study was to evaluate proton pump inhibitor (PPI) response rates for gastroesophageal reflux disease (GERD) phenotypes and functional heartburn (FH) according to the different diagnostic techniques. METHODS: This was a retrospective, noninterventional, single-center study, presenting real-life data. Among 1,233 patients, 510 patients agreed to respond and were evaluated via a validated questionnaire consisting of 28 questions. Patients were classified into: Group I (n=54) if the diagnosis was based only on history, Group II (n=151) if diagnosis was documented on history and upper gastrointestinal endoscopy (UGE), and Group III (n=305) if diagnosis was based on history, UGE, high-resolution manometry and intraesophageal 24-h ambulatory pH-impedance monitoring. Patients were classified into 5 phenotypes (according to the final diagnosis): erosive esophagitis (EE) (n=117), non-erosive reflux disease (NERD) (n=94), FH (n=58), reflux hypersensitivity (RH) (n=16) and Barrett esophagus (BE) (n=20). A response rate under 50% was accepted as being nonresponsive with double doses after 8 weeks of treatment. A very good response was defined as being over 80% improvement of typical symptoms. RESULTS: The response rates for heartburn and regurgitation of all the patients were 85.3% and 82.2%, respectively. The heartburn and regurgitation response rates of Group I patients were 79.6% and 70.4%; 91.4% and 85.4% for Group II; whereas 83.3% and 82.6% for Group III. The heartburn and regurgitation response rates of BE were 90% and 90%, for EE 88% and 87.2%, for NERD 85.2% and 85.1%, for RH 68.8% and 62.5% and for FH 72.4% and 74.1%. Response rates for both heartburn and regurgination were 40% in BE, 41.4% in EE, 18.8% in NERD, 24.1% in RH and 15.5% in FH. CONCLUSIONS: We demonstrated higher PPI response rates than Western populations in all the GERD patients. More than 1/3 of the patients exhibited very good response rates for both heartburn and regurgitation. The response rates of patients who were diagnosed via all the diagnostic modalities are lower than those who were diagnosed via only history and UGE.