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 In contrast, symptoms in patients with confirmed gastroesophageal
reflux disease (GERD) that didn’t respond to acid-suppressing drugs
were associated with reflux severity, Dr. Rena Yadlapati of the
University of Colorado Anschutz Medical Campus in Aurora and her
colleagues found.
“Our results support the interplay between psychosocial factors and
symptom generation for PPI non-responders with normal physiology,”
the researchers write in American Journal of Gastroenterology.
These results are important in understanding various types of PPI
non-responders and formulating personalized management strategies,
they add.
As many as half of people with symptoms of reflux don’t get better
with proton pump inhibitors (PPIs), the researchers note. To better
understand how patients who don’t respond to PPIs perceive their
symptoms, they tested esophageal function in 192 patients who had
persistent heartburn despite being on double-doses of the
medications for at least eight weeks.
Among the 125 patients who underwent testing while on PPIs, 58
percent were classified as having functional disease, meaning that
testing found no evidence of esophageal dysfunction or reflux
despite patients perceiving symptoms.
Another 34 percent were diagnosed with GERD because acid levels and
other tests did indicate dysfunction in addition to the reported
symptoms. Nine percent had reflux hypersensitivity, meaning the
esophagus is extra sensitive to even slight reflux.
Among the 67 patients tested while off PPIs, 58 percent were found
to have functional disease, 24 percent had GERD and 18 percent had
reflux hypersensitivity.
For people with functional disease but no GERD diagnosis, the more
severe the perceived symptoms the greater was their distress and
difficulty swallowing. Their quality of life was also worse.
However, their symptoms did not track with the physiological data
from diagnostic testing for GERD.
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In patients with confirmed GERD, symptom severity was tied to the
number of reflux-associated symptoms and physiological measures of
reflux, but it was not linked to psychosocial stressors or quality
of life impairment.
“These results underscore the importance of reassurance,
psychosocial support, and coping mechanisms” when treating patients
with functional heartburn, the researchers write.
The findings also support the idea that functional heartburn and
functional difficulty swallowing, known as dysphagia, “exist on the
same reflux spectrum,” they add, so non-drug treatments for
dysphagia such as eating upright and chewing carefully could be
recommended.
For patients with GERD that does not respond to PPI, the researchers
write, “antireflux management strategies, such as increased acid
suppression, reflux inhibition, and restoration of the antireflux
barrier, are appropriate treatment considerations.”
Dr. Yadlapati was not available for an interview by press time.
SOURCE: http://go.nature.com/2y6ExMz American Journal of
Gastroenterology, online September 12, 2017.
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