pH Impedance Monitoring on Proton Pump Inhibitor Therapy Impacts Management Decisions in Proven GERD but Not in Unproven GERD
Abstract
Background & aims: Ambulatory reflux monitoring off proton pump inhibitors (PPIs) is useful in unproven gastroesophageal reflux disease (GERD). In this prospective clinical trial, we evaluated if on-PPI pH-impedance monitoring provides value in unproven GERD.
Methods: Patients with typical reflux symptoms with incomplete PPI response were studied both off PPI (wireless pH monitoring) and on PPI (pH-impedance monitoring) at 2 tertiary care centers. Patients and investigators were blinded to reflux testing findings, and patients were asked to self-resume PPI for uncontrolled symptoms despite rescue antacids. Data analysis determined if on-PPI pH-impedance findings correlated with off-PPI acid exposure time (AET) or influenced PPI-related decision making.
Results: Of 79 patients, all 26 (32.9%) with refractory GERD metrics on-PPI had proven GERD off-PPI. In 60 patients with proven GERD off-PPI, 56.7% had no ongoing GERD on PPI. No on-PPI pH-impedance findings predicted PPI decision making among conclusive, borderline, or no reflux (P = .872); AET (P = .107); reflux episodes numbers (P = .113); mean nocturnal baseline impedance (P = .621); and reflux-symptom association categories (P = .363). In multivariable linear and logistic regression models, off-PPI AET modestly predicted refractory GERD (odds ratio, 1.34; 95% confidence interval, 1.11-1.63; P = .003), and reflux episode numbers were borderline in predicting conclusive GERD off-PPI (odds ratio, 1.00; 95% confidence…
How strong is the evidence?
Evidence Hub reads this as a clinical trial, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 79 participants or records.
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