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Clinical, but not oesophageal pH-impedance, profiles predict response to proton pump inhibitors in gastro-oesophageal reflux disease
  1. Frank Zerbib1,2,
  2. Kafia Belhocine3,4,
  3. Mireille Simon1,2,
  4. Maylis Capdepont1,2,
  5. François Mion5,6,
  6. Stanislas Bruley des Varannes3,4,
  7. Jean-Paul Galmiche3,4
  1. 1Gastroenterology and Hepatology Department, CHU Bordeaux, Saint André Hospital, Bordeaux, France
  2. 2Université Bordeaux Segalen, Bordeaux, France
  3. 3Institut des Maladies de l'Appareil Digestif, CIC-INSERM, CHU Nantes, Nantes, France
  4. 4Université de Nantes, Nantes, France
  5. 5Digestive Physiology department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
  6. 6Université Claude Bernard Lyon 1, Lyon, France
  1. Correspondence to Professor Frank Zerbib, Gastroenterology and Hepatology Department, CHU Bordeaux, Saint André Hospital, Bordeaux, 1 rue Jean Burguet, Bordeaux F-33075, France; frank.zerbib{at}


Objective Approximately 30% of patients with gastro-oesophageal reflux disease (GORD) do not achieve adequate symptom control with proton pump inhibitors (PPIs). The aim of this study was to determine whether any symptom profile or reflux pattern was associated with refractoriness to PPI therapy.

Design Patients with typical GORD symptoms (heartburn and/or regurgitation) were included and had 24 h pH-impedance monitoring off therapy. Patients were considered to be responders if they had fewer than 2 days of mild symptoms per week while receiving a standard or double dose of PPI treatment for at least 4 weeks. Both clinical and reflux parameters were taken into account for multivariate analysis (logistic regression).

Results One hundred patients were included (median age 50 years, 42 male), 43 responders and 57 non-responders. Overall, multivariate analysis showed that the factors associated with the absence of response were absence of oesophagitis (p=0.050), body mass index (BMI) ≤25 kg/m2 (p=0.002) and functional dyspepsia (FD) (p=0.001). In patients who reported symptoms during the recording (n=85), the factors associated with PPI failure were BMI ≤25 kg/m2 (p=0.004), FD (p=0.009) and irritable bowel syndrome (p=0.045). In patients with documented GORD (n=67), the factors associated with PPI failure were absence of oesophagitis (p=0.040), FD (p=0.003), irritable bowel syndrome (p=0.012) and BMI ≤25 kg/m2 (p=0.029).

Conclusion No reflux pattern demonstrated by 24 h pH-impedance monitoring is associated with response to PPIs in patients with GORD symptoms. In contrast, absence of oesophagitis, presence of functional digestive disorders and BMI ≤25 kg/m2 are strongly associated with PPI failure.

  • Gastro-oesophageal reflux
  • proton pump inhibitors
  • oesophageal impedance
  • functional digestive disorders
  • gastroesophageal reflux disease
  • oesophageal impedance
  • oesophageal motility
  • anti-reflux therapy
  • gastro-oesophageal junction
  • manometry
  • anal incontinence
  • gastroparesis
  • liver function test
  • achalasia
  • gastric physiology
  • lower oesophageal sphincter
  • anorectal physiology
  • 13C-urea breath test
  • gastric inflammation
  • anti-reflux therapy
  • gastroduodenal motility
  • gastric diseases
  • short chain fatty acids
  • endoscopic procedures

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  • Competing interests FZ has served as a speaker, a consultant and an advisory board member for Addex Pharma SA, Xenoport, Movetis, Norgine, Sanofi Aventis, Astrazeneca, Janssen Cilag, Renckitt Benckiser, Abbott, Pfizer, Given Imaging and has received research funding from Nycomed. FM has served as a consultant to Addex Pharma. SBdesV has served as a speaker, a consultant and/or an advisory board member for Astra Zeneca, Janssen Cilag, Takeda, Danone research, Cephalon, Iprad, Given Imaging, Novartis, Ipsen Beaufour, Nycomed. JPG has served as a speaker, a consultant and an advisory board member for Addex Pharma SA, Xenoport, Movetis, Norgine, AstraZeneca, Janssen Cilag, Renckitt Benckiser, Given Imaging, Mauna Kea Technologies and has received research funding from AstraZeneca, Mauna Kea Technologies, Given Imaging and Janssen-Cilag. KB, MS and MC have no competing interests to disclose.

  • Provenance and peer review Not commissioned; externally peer reviewed.