World Congress of Gastroenterology

WCOG 2019

Effect of advanced diagnosis modalities and disease phenotypes on PPI response of Gastroesophageal Reflux Disease


 In Western countries, response rates for proton pump inhibitors (PPIs) are about 60-70% and higher in heartburn than regurgitation. The differences between response rates in phenotypes have not been adequately investigated. We evaluated PPI response rates of Barrett’s esophagus (BE), erosive esophagitis (EE), nonerosive (NERD), esophageal hypersensitivity esophagus (EH) phenotypes and functional heartburn (FH), and success rates according to the different diagnostic techniques.

Materials and Methods:

 Patients were randomly chosen among the patients from the database of Ege University Reflux outpatient clinic who were on continue PPIs.  Among 1233 patients, 510 patients who accepted to response phone survey were included. Exclusion criteria were medications which other than PPIs and influence the study, upper gastrointestinal surgeries, cholecystectomy, major comorbidity, pregnancy. Subjects were evaluated with a validated questionnaire consisted of 28 questions.


 54 of those patients were diagnosed with only history. 151 patients were evaluated with history and UGE. 305 patients were underwent to UGE, HRM and 24 h intraesophageal MII-pH (off-PPI).  Last group was classified into EE (117), NERD (94), EH (16), FH (58) BE (20). Response rate under 50% for either heartburn and/or regurgitation was accepted as unresponsive. Cumulative response rates for heartburn and regurgitation were 85.3% and 82.2% respectively. When the effect of advanced diagnostic modalities on response rates for heartburn and regurgitation among phenotypes were evaluated, the highest rate was in history + UGE group (91.4%, 85.4% respectively).


  We found a higher PPIs response rate than Western populations in all GERD patients. Response rate was not different in regurgitation compared to heartburn. When it is investigated according to the groups, response rate was highest in EE and lowest in EH and FH. Interestingly, response rates were similar between EE and NERD. It should be noted that these results were belong to a single/tertiary referral center with difficult to treat cases. Probably due to this reason, response rates of patients who were diagnosed by using all diagnostic modalities are lower than those who were diagnosed with only history and UGE.


 erosive esophagitis, nonerosive esophageal reflux disease, esophageal hypersensitivity, functional heartburn (FH)