Clinical Characteristics of Refractory GERD Patients Investigated

An estimated 10% to 40% of gastroesophageal reflux disease (GERD) patients on proton pump inhibitor (PPI) therapy continue to have significant symptoms. Since little is known about how the clinical characteristics of patients who respond to PPIs differ from those of patients who fail to respond, a group of researchers in Israel undertook a study to investigate. Their results were published in the October edition of the Journal of Neurogastroenterology and Motility.

The study included 245 GERD patients (59.3% female, average age 52.3) who had received PPI therapy (omeprazole 20 mg) once or twice daily for at least three months. All participants completed a questionnaire and an interview about their demographics, habits, compliance and adherence to treatment, clinical characteristics, and endoscopic findings. The participants were divided into three groups: those who fully responded to once-daily PPI therapy (group A, 111 patients), those who failed to respond to once-daily PPI therapy (group B, 78 patients), and those who failed to respond to twice-daily PPI therapy (group C, 56 patients). (Failure to respond was defined as experiencing heartburn and acid regurgitation at least three times a week.)

The following differences among the groups (A vs. B vs. C) were found: hiatal hernia (33% vs. 51% vs. 52%); erosive esophagitis (19% vs. 51% vs. 30%); sleep disturbance (19% vs. 30% vs. 38%); chest symptoms (21% vs. 35% vs. 41%); Helicobacter pylori infection (25% vs. 33% vs. 48%); average disease duration (1.6 years vs. 1.9 years vs. 2.0 years); performed lifestyle interventions (68.5% vs. 46.7% vs. 69.6%); and treatment compliance and adherence (84% vs. 55% vs. 46%). (Compliance was defined as taking medication daily, and adherence was defined as taking medication on an empty stomach, a half hour before a meal.)

The researchers noted that the results point to several low-cost routes to improving levels of response to PPI therapy. “In light of these findings and consistent with findings in other studies, it seems prudent to recommend assessment of compliance and lifestyle modifications, such as weight control and late-night meals, in all GERD patients who report lack of response to PPI treatment,” they wrote.