Continued PPI use and gastrointestinal evaluations after a negative pH study in patients with throat symptoms from possible extraesophageal GERD.

IF 1.3 4区医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Acta gastro-enterologica Belgica Pub Date : 2024-04-01 DOI:10.51821/87.2.12969

D L Cohen, V Richter, A Mari, H Shirin, A Bermont

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Abstract

Background: Recent guidelines have advocated for upfront pH testing in patients with isolated symptoms of extra-esophageal gastrointestinal reflux disease (EE-GERD) under the assumption that a negative pH study will prevent further gastrointestinal (GI) investigations, proton pump inhibitor (PPI) use, and reduce cost. We sought to evaluate if this actually occurs.

Methods: A retrospective study was performed on patients who underwent 24-hour combined pH-impedance testing off PPI for suspected EE-GERD. A negative study was defined as DeMeester score <14.7.

Results: 59 patients were included (mean age 53.2; 50.8% women). Most (38, 64.4%) had a negative study. Findings of laryngopharyngoreflux on laryngoscopy did not predict pH results. Those with a negative study had the same number of followup GI appointments, repeat endoscopies, and repeat pH studies compared to those with a positive study (p=NS). While PPIs were more frequently stopped in those with a negative pH study, still 14 (36.8%) were continued on a PPI. At the end of the follow-up period (mean 43.6 months), 18 (47.4%) subjects with a negative pH study were still prescribed PPIs. Patients who were diagnosed with post-nasal drip or rhinits were significantly less likely to still be receiving a PPI (5.6% vs 35.0%, p=0.045).

Conclusions: Despite a negative pH study, a substantial number of patients with isolated EE-GERD symptoms are continued on a PPI and they undergo GI follow-up at the same rate as those with a positive study. These findings bring into question the recent recommendations for upfront pH testing in suspected EE-GERD and its reported cost savings.

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在对可能患有食管外胃食管反流病的咽喉症状患者进行 pH 值检测呈阴性后，继续使用 PPI 并进行胃肠道评估。

背景：最近的指南提倡对有食管外胃肠道反流病（EE-GERD）孤立症状的患者进行前期 pH 值检测，其假设是，阴性 pH 值检测可避免进一步的胃肠道（GI）检查、质子泵抑制剂（PPI）的使用并降低成本。我们试图评估这种情况是否确实存在：我们对疑似 EE 胃食管反流病的患者进行了一项回顾性研究，这些患者接受了 24 小时 pH- 阻抗联合检测，未使用 PPI。结果：共纳入 59 名患者（平均年龄 53 岁）：共纳入 59 名患者（平均年龄 53.2 岁；50.8% 为女性）。大多数患者（38 人，64.4%）的研究结果为阴性。喉镜检查发现的喉咽反流并不能预测 pH 值结果。与pH值为阳性的患者相比，pH值为阴性的患者接受消化道复诊、重复内镜检查和重复pH值检查的次数相同（p=NS）。虽然 pH 值阴性者更常停用 PPI，但仍有 14 人（36.8%）继续服用 PPI。在随访期结束时（平均 43.6 个月），有 18 名（47.4%）pH 值阴性的受试者仍在服用 PPI。被诊断为鼻后滴流或鼻炎的患者继续服用 PPI 的可能性明显较低（5.6% vs 35.0%，P=0.045）：结论：尽管pH值研究结果呈阴性，但仍有相当多的孤立性EE-胃食管反流症状患者继续服用PPI，而且他们接受消化道随访的比例与研究结果呈阳性的患者相同。这些研究结果使人们对最近提出的对疑似 EE-GERD 患者进行前期 pH 值检测的建议及其节约成本的报道产生了质疑。

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来源期刊

Acta gastro-enterologica Belgica Medicine-Gastroenterology

CiteScore

2.30

自引率

20.00%

发文量

期刊介绍： The Journal Acta Gastro-Enterologica Belgica principally publishes peer-reviewed original manuscripts, reviews, letters to editors, book reviews and guidelines in the field of clinical Gastroenterology and Hepatology, including digestive oncology, digestive pathology, as well as nutrition. Pure animal or in vitro work will not be considered for publication in the Journal. Translational research papers (including sections of animal or in vitro work) are considered by the Journal if they have a clear relationship to or relevance for clinical hepato-gastroenterology (screening, disease mechanisms and/or new therapies). Case reports and clinical images will be accepted if they represent an important contribution to the description, the pathogenesis or the treatment of a specific gastroenterology or liver problem. The language of the Journal is English. Papers from any country will be considered for publication. Manuscripts submitted to the Journal should not have been published previously (in English or any other language), nor should they be under consideration for publication elsewhere. Unsolicited papers are peer-reviewed before it is decided whether they should be accepted, rejected, or returned for revision. Manuscripts that do not meet the presentation criteria (as indicated below) will be returned to the authors. Papers that go too far beyond the scope of the journal will be also returned to the authors by the editorial board generally within 2 weeks. The Journal reserves the right to edit the language of papers accepted for publication for clarity and correctness, and to make formal changes to ensure compliance with AGEB’s style. Authors have the opportunity to review such changes in the proofs.