PMID- 28895583
OWN - NLM
STAT- MEDLINE
DCOM- 20190626
LR  - 20231112
IS  - 1572-0241 (Electronic)
IS  - 0002-9270 (Print)
IS  - 0002-9270 (Linking)
VI  - 113
IP  - 1
DP  - 2018 Jan
TI  - Psychosocial Distress and Quality of Life Impairment Are Associated With Symptom 
      Severity in PPI Non-Responders With Normal Impedance-pH Profiles.
PG  - 31-38
LID - 10.1038/ajg.2017.263 [doi]
AB  - OBJECTIVES: Up to 50% of patients with reflux symptoms do not manifest a 
      satisfactory symptom response to proton pump inhibitor (PPI) therapy. Our primary 
      aim in this study was to identify factors associated with symptom perception 
      among PPI non-responder phenotypes. METHODS: This prospective observational 
      cohort study was performed from September 2014 to January 2017 at a single 
      academic medical center and included PPI non-responders who underwent 24-h 
      impedance-pH monitoring and completed a questionnaire set measuring 
      patient-reported symptom severity, quality of life (QOL), and psychosocial 
      distress. Participants were separated into cohorts based on impedance-pH results: 
      on PPI: -acid exposure time (AET)/-symptom-reflux association (SRA), +AET, and 
      -AET/+SRA; off PPI: functional (-AET/-SRA), gastroesophageal reflux disease 
      (GERD) (+AET), and reflux hypersensitivity (RHS) (-AET/+SRA). The primary outcome 
      was abnormal GERD symptom severity defined by GerdQ>/=8. RESULTS: One hundred and 
      ninety-two participants were included. Impedance-pH on PPI was performed on 125: 
      72 (58%) -AET/-SRA, 42 (34%) +AET, and 11 (9%) -AET/+SRA. Among the -AET/-SRA 
      group, younger age, higher dysphagia scores, QOL impairment, and higher brief 
      symptom index were associated with GerdQ>/=8. Among the +AET group, higher number 
      of reflux-associated symptoms and lower distal contractile integral was 
      associated with GerdQ>/=8. Impedance-pH off PPI was performed on 67 participants: 
      39 (58%) functional, 16 (24%) GERD, and 12 (18%) RHS. Among the functional group, 
      higher QOL impairment and dysphagia scores were seen with GerdQ>/=8. CONCLUSIONS: 
      Perceptions of reflux symptoms are associated with psychosocial distress, reduced 
      QOL, and sensation of dysphagia among PPI non-responders with normal 
      impedance-pH. Among PPI refractory GERD patients, patient-reported symptom 
      severity is associated with physiological differences, as opposed to psychosocial 
      factors.
FAU - Yadlapati, Rena
AU  - Yadlapati R
AD  - Division of Gastroenterology & Hepatology, University of Colorado Anschutz 
      Medical Campus, Aurora, Colorado, USA.
FAU - Tye, Michael
AU  - Tye M
AD  - Division of Gastroenterology & Hepatology, Northwestern University Feinberg 
      School of Medicine, Chicago, Illinois, USA.
FAU - Keefer, Laurie
AU  - Keefer L
AD  - Mount Sinai School of Medicine, New York, New York, USA.
FAU - Kahrilas, Peter J
AU  - Kahrilas PJ
AD  - Division of Gastroenterology & Hepatology, Northwestern University Feinberg 
      School of Medicine, Chicago, Illinois, USA.
FAU - Pandolfino, John E
AU  - Pandolfino JE
AD  - Division of Gastroenterology & Hepatology, Northwestern University Feinberg 
      School of Medicine, Chicago, Illinois, USA.
LA  - eng
GR  - R01 DK092217/DK/NIDDK NIH HHS/United States
GR  - T32 DK101363/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, N.I.H., Extramural
DEP - 20170912
PL  - United States
TA  - Am J Gastroenterol
JT  - The American journal of gastroenterology
JID - 0421030
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Adult
MH  - Cohort Studies
MH  - Deglutition Disorders/etiology/pathology/physiopathology
MH  - Electric Impedance
MH  - Esophageal pH Monitoring
MH  - Female
MH  - Gastroesophageal Reflux/complications/*drug therapy/physiopathology/psychology
MH  - Humans
MH  - Male
MH  - Manometry
MH  - Middle Aged
MH  - Patient Reported Outcome Measures
MH  - Patient Satisfaction
MH  - Prospective Studies
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - *Quality of Life
MH  - Severity of Illness Index
MH  - *Stress, Psychological
MH  - Treatment Failure
MH  - Young Adult
PMC - PMC5772841
MID - NIHMS933503
COIS- Potential Conflict of Interest (Financial, Professional or Personal): None
EDAT- 2017/09/13 06:00
MHDA- 2019/06/27 06:00
PMCR- 2019/01/01
CRDT- 2017/09/13 06:00
PHST- 2017/03/31 00:00 [received]
PHST- 2017/07/18 00:00 [accepted]
PHST- 2017/09/13 06:00 [pubmed]
PHST- 2019/06/27 06:00 [medline]
PHST- 2017/09/13 06:00 [entrez]
PHST- 2019/01/01 00:00 [pmc-release]
AID - 10.1038/ajg.2017.263 [doi]
PST - ppublish
SO  - Am J Gastroenterol. 2018 Jan;113(1):31-38. doi: 10.1038/ajg.2017.263. Epub 2017 
      Sep 12.