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Use of Esophageal pH Monitoring to Minimize Proton-Pump Inhibitor Utilization in Patients with Gastroesophageal Reflux Symptoms

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Abstract

Background

Due to concerns about long-term PPI use in patients with acid reflux, we aimed at minimizing PPI use, either by avoiding initiating therapy, downscaling to other therapies, or introducing endoscopic or surgical options.

Aims

To examine the role of esophageal ambulatory pHmetry in minimizing PPI use in patients with heartburn and acid regurgitation.

Methods

Retrospective cohort analysis of patients with reflux symptoms, who underwent endoscopy, manometry, and ambulatory pHmetry to define the need for PPI. Patients were classified as: (1) never users; (2) partial responders to PPI; (3) users with complete response to PPI. Patients were then managed as: (1) PPI non-users; (2) PPI-initiated, and (3) PPI-continued.

Results

Of 286 patients with heartburn and regurgitation, 103 (36%) were found to have normal and 183 (64%) abnormal esophageal acid exposure (AET). In the normal AET group, 44/103 had not been treated and were not initiated on PPI. Of the 59 who had previously received PPI, 52 stopped and 7 continued PPI. Hence, PPI were avoided in 96/103 patients (93%). In the abnormal AET group, 61/183 had not been treated and 38 were initiated on PPI and 23 on other therapies. In the 122 patients previously treated with PPI, 24 were not treated with PPI, but with H2RAs, prokinetics, endoscopic, or surgical therapy. Hence, PPI therapy was avoided in 47/183 patients (26%).

Conclusions

In patients with GER symptoms, esophageal pHmetry may avert PPI use in 50%. In the era of caution regarding PPIs, early testing may provide assurance and justification.

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Abbreviations

GERD:

Gastroesophageal reflux disease

PPI:

Proton-pump inhibitors

HRM:

High-resolution manometry

H2RA:

Histamine-2 receptor agonists

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Authors and Affiliations

  1. Stanford Esophageal Multidisciplinary Program in Innovative Research Excellence (SEMPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, M-211, Stanford, CA, 94305, USA

    George Triadafilopoulos, Thomas Zikos, Kirsten Regalia, Irene Sonu, Nielsen Q. Fernandez-Becker, Linda Nguyen, Monica Christine R. Nandwani & John O. Clarke

Authors
  1. George Triadafilopoulos
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  2. Thomas Zikos
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  3. Kirsten Regalia
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  4. Irene Sonu
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  5. Nielsen Q. Fernandez-Becker
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  6. Linda Nguyen
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  7. Monica Christine R. Nandwani
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  8. John O. Clarke
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Contributions

GT planned and/or conducted the study, and all authors collected and/or interpreted the data and drafted and revised the manuscript.

Corresponding author

Correspondence to George Triadafilopoulos.

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The authors declare that they have no conflict of interest.

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Cite this article

Triadafilopoulos, G., Zikos, T., Regalia, K. et al. Use of Esophageal pH Monitoring to Minimize Proton-Pump Inhibitor Utilization in Patients with Gastroesophageal Reflux Symptoms. Dig Dis Sci 63, 2673–2680 (2018). https://doi.org/10.1007/s10620-018-5183-4

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  • DOI: https://doi.org/10.1007/s10620-018-5183-4

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