Source/Disclosures
Disclosures: Yadlapati reports serving as a consultant for Medtronic, Ironwood Pharmaceuticals and Diversatek; receiving research support from Ironwood Pharmaceuticals and is on the advisory board for Phathom Pharmaceuticals. Please see the full study for all other authors’ relevant financial disclosures.

September 16, 2020
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Acid exposure reflux monitoring predicts PPI discontinuation in GERD

Source/Disclosures
Disclosures: Yadlapati reports serving as a consultant for Medtronic, Ironwood Pharmaceuticals and Diversatek; receiving research support from Ironwood Pharmaceuticals and is on the advisory board for Phathom Pharmaceuticals. Please see the full study for all other authors’ relevant financial disclosures.

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Acid exposure reflux monitoring predicted the ability to discontinue proton pump inhibitor use without symptom escalation among patients with gastroesophageal reflux disease and inadequate proton pump inhibitor response.

“This study is the first of its kind to provide high-level evidence in support of early reflux monitoring of acid suppression in order to phenotype the patient with inadequate PPI response, and personalize care accordingly,” Rena Yadlapati, MD MS, from the division of gastroenterology at the University of California, San Diego School of Medicine and colleagues wrote. “A phenotype guided care approach for patients with suspected GERD and inadequate PPI response has tremendous implications for health-related quality of life and resource utilization associated with GERD.”

Yadlapati and colleagues enrolled 128 patients with heartburn, regurgitation, chest pain and inadequate PPI response into a double-blind clinical trial over 3 years at two centers. One hundred patients met inclusion criteria and remained in the study. Patients underwent prolonged wireless reflux monitoring (off PPI for over 7 days) followed by a 3-week PPI cessation intervention. Tolerance of PPI cessation —discontinued or resumed PPI — served as the primary outcome. Investigators used the Reflux Symptom Questionnaire electronic diary to quantify symptom burden.

Thirty-four patients continued PPIs. The number of days with acid exposure time over 4% (OR = 1.82; P < .001) was the strongest predictor for PPI discontinuation. Investigators reported that patients with 0 days of acid exposure time over 4% had a 10 times increased chance for discontinuation of PPI compared with patients with 4 days of acid exposure time over 4%.

According to researchers, reduction in symptom burden was greater in the discontinued PPI group compared with the resumed PPI group (RESQ-eD –43.7% vs. –5.3%; P = .04).

“Upfront reflux monitoring off acid suppression can limit unnecessary PPI use and guide personalized management,” the researchers wrote.