GERD patients with early satiation, vomiting at risk for poor response to PPIs
Certain dyspepsia symptoms, including early satiation and vomiting, were associated with an increased risk for poor response to proton pump inhibitors in patients with GERD, according to the results of an Italian study.
“In a recent review, [functional dyspepsia] has been found to be more prevalent in GERD patients who had the worst response to PPIs, likely suggesting that coexisting dyspepsia is a risk factor for refractory GERD,” investigators wrote. “However, the impact of specific dyspepsia symptoms in the subset of refractory GERD patients has not yet been systematically reported.”
To determine the relationship between specific dyspepsia symptoms and response to PPIs in GERD patients, the investigators screened 132 consecutive GERD patients, all of whom underwent a 24-hour pH-impedance test while on PPI therapy, and reported functional dyspepsia symptoms via questionnaire.
Among the screened patients, the researchers identified 67 PPI responders (38 women; mean age, 54 years) and 33 refractory patients (21 women; mean age, 58 years). Dyspepsia symptoms were more prevalent among the refractory patients (64% vs. 37%; P < .01), as were individual symptoms including post-prandial fullness, nausea, vomiting, early satiation and epigastric pain (P < .05 for all) but not bloating or belching.
Multivariate analysis showed that only early satiation (OR = 4; 95% CI, 1–14) and vomiting (OR = 7; 95% CI, 1.4–34) were associated with poor response to PPIs.
“Also, the coexistence of several dyspeptic symptoms was associated with the worst clinical outcome in GERD patients (P < 0.05); however, specifically excluding early satiation from this analysis, no significant differences in terms of PPI response were found between patients with one or more dyspeptic symptoms,” the researchers wrote.
“Our study confirms the close relationship between [functional dyspepsia] and GERD, highlighting that specific dyspeptic symptoms influence the rate of response to PPIs,” they concluded. “These findings may guide further pathophysiological studies and help clinicians in the management of refractory GERD.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.