PMID- 25294046
OWN - NLM
STAT- MEDLINE
DCOM- 20161012
LR  - 20161230
IS  - 1442-2050 (Electronic)
IS  - 1120-8694 (Linking)
VI  - 29
IP  - 1
DP  - 2016 Jan
TI  - Survey of findings in patients having persistent heartburn on proton pump 
      inhibitor therapy.
PG  - 27-33
LID - 10.1111/dote.12293 [doi]
AB  - In patients with refractory heartburn while on proton pump inhibitor (PPI) 
      therapy, changing drugs or increasing treatment to a twice a day (b.i.d.) dose 
      has become a common practice. This study aims to study patients with persistent 
      heartburn while on PPI therapy and to determine if persistent symptom indicates 
      the need for more aggressive or different therapy. A retrospective review of 
      impedance-pH tracings on PPI therapy (q.d. or b.i.d.) for patients with 
      persistent heartburn was performed. DeMeester score, impedance, and symptom 
      sensitive index (SSI) were used as indices. Statistical analyses were performed 
      using chi-squared test with Yates correction and paired t-test. One hundred 
      consecutive patients, (female 50%, male 50%, mean age 54 [range 16-83] years) 
      were studied on q.d. (n = 45) or b.i.d. PPI (n = 55). Only 20% of the patients 
      had abnormal DeMeester score; 41% had an abnormal impedance score and 56% had 
      abnormal SSI; 29% had all indices normal. There was no difference between 
      patients taking q.d. versus b.i.d. PPI for abnormal DeMeester score (22 vs. 18%), 
      impedance (38 vs. 44%) and SSI (53 vs. 58%); P = 0.80, 0.69, and 0.77, 
      respectively. In 56 patients with positive SSI, symptoms were due to acid reflux 
      in 8 (14%) patients, nonacid reflux in 31 (55%) patients, and combined acid and 
      nonacid reflux in 17 (30%) patients. Patients with persistent heartburn on PPI 
      therapy show a variety of disorders: (i) acid reflux (20%); (ii) nonacid reflux 
      (26%); (iii) positive SSI (56%); (iv) all normal indices (29%). These studies 
      indicate that persistent heartburn on PPI therapy is a complex problem that may 
      not respond to simply increasing acid inhibition.
CI  - (c) 2014 International Society for Diseases of the Esophagus.
FAU - Mandaliya, R
AU  - Mandaliya R
AD  - Division of Internal Medicine, Abington Memorial Hospital, Abington, 
      Pennsylvania, USA.
FAU - DiMarino, A J
AU  - DiMarino AJ
AD  - Division of Gastroenterology and Hepatology, Thomas Jefferson University 
      Hospital, Philadelphia, Pennsylvania, USA.
FAU - Cohen, S
AU  - Cohen S
AD  - Division of Gastroenterology and Hepatology, Thomas Jefferson University 
      Hospital, Philadelphia, Pennsylvania, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20141008
PL  - United States
TA  - Dis Esophagus
JT  - Diseases of the esophagus : official journal of the International Society for 
      Diseases of the Esophagus
JID - 8809160
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Dose-Response Relationship, Drug
MH  - Drug Resistance
MH  - Electric Impedance
MH  - Esophageal pH Monitoring/methods
MH  - Female
MH  - *Gastroesophageal Reflux/complications/diagnosis/drug therapy/physiopathology
MH  - *Heartburn/diagnosis/etiology/physiopathology
MH  - Humans
MH  - Hydrogen-Ion Concentration
MH  - Male
MH  - Middle Aged
MH  - *Proton Pump Inhibitors/administration & dosage/pharmacology
MH  - Retrospective Studies
MH  - Surveys and Questionnaires
MH  - Symptom Assessment
OTO - NOTNLM
OT  - DeMeester score
OT  - gastroesophageal reflux disease
OT  - heartburn
OT  - impedance
OT  - proton pump inhibitor
OT  - symptom sensitivity index
EDAT- 2014/10/09 06:00
MHDA- 2016/10/13 06:00
CRDT- 2014/10/09 06:00
PHST- 2014/10/09 06:00 [entrez]
PHST- 2014/10/09 06:00 [pubmed]
PHST- 2016/10/13 06:00 [medline]
AID - 10.1111/dote.12293 [doi]
PST - ppublish
SO  - Dis Esophagus. 2016 Jan;29(1):27-33. doi: 10.1111/dote.12293. Epub 2014 Oct 8.