Can Esophageal Baseline Impedance Predict Proton Pump Inhibitor Response in Gastroesophageal Reflux Disease?
Abstract
c 2018 The Korean Society of Neurogastroenterology and Motility J Neurogastroenterol Motil, Vol. 24 No. 1 January, 2018 www.jnmjournal.org Gastroesophageal reflux disease (GERD) is characterized by reflux of stomach contents and causes unpleasant symptoms and complications. Proton pump inhibitors (PPIs) are widely used to treat GERD and significantly reduce gastric acid secretion. However, despite PPI therapy, up to 40% of patients report persistent GERD symptoms. Some studies have attempted to predict which patients will have a poor response to PPI treatment. A recently published review article reported that poor response to PPI treatment is related to a PPI-metabolizer genotype, CYP, and requires combined adjunctive therapy. Adjusting treatment in patients with the PPI-metabolizer genotype or switching to a CYP2C19-independent PPI is a simple way to increase the PPI response. In addition, the use of adjunctive agents may be considered when the physiological mechanism of PPI nonresponse is suspected. For such patients, recent research focused on whether the diagnosis is truly correct and the degree of treatment response can be predicted. According to the recent implementation of a pH monitoring method combined with baseline impedance (BI), and depending on the degree of acid exposure and esophageal hypersensitivity highlighted in the Rome IV criteria for functional esophageal disorders, patients with suspected GERD with typical chest pain and regurgitation are divided into…
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