PMID- 35973148
OWN - NLM
STAT- MEDLINE
DCOM- 20230104
LR  - 20231002
IS  - 1572-0241 (Electronic)
IS  - 0002-9270 (Print)
IS  - 0002-9270 (Linking)
VI  - 117
IP  - 10
DP  - 2022 Oct 1
TI  - Optimal Wireless Reflux Monitoring Metrics to Predict Discontinuation of Proton 
      Pump Inhibitor Therapy.
PG  - 1573-1582
LID - 10.14309/ajg.0000000000001871 [doi]
AB  - INTRODUCTION: Ambulatory reflux monitoring performed off proton pump inhibitor 
      (PPI) is the gold standard diagnostic test for nonerosive gastroesophageal reflux 
      disease (GERD). However, the diagnostic metrics and optimal duration of 
      monitoring are not well defined. This study evaluated the performance of multiple 
      metrics across distinct durations of wireless reflux monitoring off PPI against 
      the ability to discontinue PPI therapy in patients with suboptimal PPI response. 
      METHODS: This single-arm clinical trial performed over 4 years at 2 centers 
      enrolled adults with troublesome GERD symptoms and inadequate response to > 8 
      weeks of PPI. Participants underwent 96-hour wireless pH monitoring off PPI. 
      Primary outcome was whether the subject successfully discontinued PPI or resumed 
      PPI within 3 weeks. RESULTS: Of 132 participants, 30% discontinued PPI. Among 
      multiple metrics assessed, total acid exposure time (AET) of 4.0% performed best 
      in predicting PPI discontinuation (odds ratio 2.9 [95% confidence interval 1.4, 
      6.4]; P = 0.006), with other thresholds of AET and DeMeester score performing 
      comparably. AET was significantly higher on day 1 of monitoring compared with 
      other days, and prognostic performance significantly declined when only assessing 
      the first 48 hours of monitoring (area under the curve for 96 hours 0.63 vs area 
      under the curve for 48 hours 0.57; P = 0.01). DISCUSSION: This clinical trial 
      highlights the AET threshold of 4.0% as a high-performing prognostic marker of 
      PPI discontinuation. 96 hours of monitoring performed better than 48 hours, in 
      predicting ability to discontinue PPI. These data can inform current diagnostic 
      approaches for patients with GERD symptoms who are unresponsive to PPI therapy.
CI  - Copyright (c) 2022 by The American College of Gastroenterology.
FAU - Yadlapati, Rena
AU  - Yadlapati R
AUID- ORCID: 0000-0002-7872-2033
AD  - Division of Gastroenterology, University of California, San Diego School of 
      Medicine, La Jolla, California, USA.
FAU - Gyawali, C Prakash
AU  - Gyawali CP
AD  - Division of Gastroenterology, Washington University School of Medicine, St. 
      Louis, Missouri, USA.
FAU - Masihi, Melina
AU  - Masihi M
AD  - Division of Gastroenterology, Northwestern University Feinberg School of 
      Medicine, Chicago, Illinois, USA.
FAU - Carlson, Dustin A
AU  - Carlson DA
AD  - Division of Gastroenterology, Northwestern University Feinberg School of 
      Medicine, Chicago, Illinois, USA.
FAU - Kahrilas, Peter J
AU  - Kahrilas PJ
AD  - Division of Gastroenterology, Northwestern University Feinberg School of 
      Medicine, Chicago, Illinois, USA.
FAU - Nix, Billy Darren
AU  - Nix BD
AD  - Division of Gastroenterology, Washington University School of Medicine, St. 
      Louis, Missouri, USA.
FAU - Jain, Anand
AU  - Jain A
AD  - Division of Digestive Diseases, Emory University School of Medicine, Atlanta, 
      Georgia, USA.
FAU - Triggs, Joseph R
AU  - Triggs JR
AD  - Division of Gastroenterology, Department of Medicine, Perelman School of 
      Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
FAU - Vaezi, Michael F
AU  - Vaezi MF
AD  - Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University 
      Medical Center, Nashville, Tennessee, USA.
FAU - Kia, Leila
AU  - Kia L
AD  - Division of Gastroenterology, Northwestern University Feinberg School of 
      Medicine, Chicago, Illinois, USA.
FAU - Kaizer, Alexander
AU  - Kaizer A
AD  - University of Colorado, Anschutz Medical Campus, Colorado School of Public 
      Health, Department of Biostatistics and Informatics, Aurora, Colorado, USA.
FAU - Pandolfino, John E
AU  - Pandolfino JE
AD  - Division of Gastroenterology, Northwestern University Feinberg School of 
      Medicine, Chicago, Illinois, USA.
LA  - eng
SI  - ClinicalTrials.gov/NCT03202537
GR  - K23 DK125266/DK/NIDDK NIH HHS/United States
GR  - R01 DK092217/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20220610
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  - Humans
MH  - *Esophageal pH Monitoring
MH  - *Gastroesophageal Reflux/diagnosis/drug therapy
MH  - Prognosis
MH  - Proton Pump Inhibitors/therapeutic use
PMC - PMC9532366
MID - NIHMS1814711
EDAT- 2022/08/17 06:00
MHDA- 2022/10/07 06:00
PMCR- 2023/10/01
CRDT- 2022/08/16 16:04
PHST- 2022/02/01 00:00 [received]
PHST- 2022/06/08 00:00 [accepted]
PHST- 2022/08/17 06:00 [pubmed]
PHST- 2022/10/07 06:00 [medline]
PHST- 2022/08/16 16:04 [entrez]
PHST- 2023/10/01 00:00 [pmc-release]
AID - 00000434-202210000-00015 [pii]
AID - 10.14309/ajg.0000000000001871 [doi]
PST - ppublish
SO  - Am J Gastroenterol. 2022 Oct 1;117(10):1573-1582. doi: 
      10.14309/ajg.0000000000001871. Epub 2022 Jun 10.