Upper GI tract findings in patients with heartburn in whom proton pump inhibitor treatment failed versus those not receiving antireflux treatment
Received 13 May 2009; accepted 23 August 2009. published online 18 November 2009.
Background
Failure of proton pump inhibitor (PPI) treatment in patients with heartburn is very common. Because endoscopy is easily accessible, it is commonly used as the first evaluative tool in these patients.
Objective
To compare GERD-related endoscopic and histologic findings in patients with heartburn in whom once-daily PPI therapy failed versus those not receiving antireflux treatment.
Design
Cross-sectional study.
Setting
A Veterans Affairs hospital.
Patients
Heartburn patients from the GI outpatient clinic.
Intervention
Recording of endoscopic results.
Main outcome measurements
Endoscopic findings and association between PPI treatment failure and esophageal mucosal injury by using logistic regression models.
Results
A total of 105 subjects (mean age 54.7 ± 15.7 years; 71 men, 34 women) were enrolled in the PPI treatment failure group and 91 (mean age 53.4 ± 15.8 years; 68 men, 23 women) were enrolled in the no-treatment group (P = not significant). Anatomic findings during upper endoscopy were significantly more common in the no-treatment group compared with the PPI treatment failure group (55.2% vs 40.7%, respectively; P = .04). GERD-related findings were significantly more common in the no-treatment group compared with the PPI treatment failure group (erosive esophagitis: 30.8% vs 6.7%, respectively; P < .05). Eosinophilic esophagitis was found in only 0.9% of PPI treatment failure patients. PPI treatment failure was associated with a significantly decreased odds ratio of erosive esophagitis compared with no treatment, adjusted for age, sex, and body mass index (adjusted odds ratio 0.11; 95% CI, 0.04-0.30).
Conclusions
Heartburn patients in whom once-daily PPI treatment failed demonstrated a paucity of GERD-related findings compared with those receiving no treatment. Eosinophilic esophagitis was uncommon in PPI therapy failure patients. Upper endoscopy seems to have a very low diagnostic yield in this patient population.
Current affiliations: Department of Medicine, Section of Gastroenterology, The Neuroenteric Clinical Research Group, Southern Arizona VA Health Care System and University of Arizona Health Sciences Center, Tucson, Arizona, USA
Reprint requests: Ronnie Fass, MD, Southern Arizona VA Health Care System, 3601 S 6th Ave (1-111-GI), Tucson, AZ 85723-0001.
DISCLOSURE: The following author disclosed financial relationships relevant to this publication: R. Fass: Research support from AstraZeneca; speaker for and research support from Takeda; research support from Wyeth. Research supported by the Office of Research and Development at the Southern Arizona VA Health Care System. All other others disclosed no financial relationships relevant to this publication.
ABSTRACT
Upper GI tract findings in patients with heartburn in whom proton pump inhibitor treatment failed versus those not receiving antireflux treatment