TY - JOUR
T1 - Upper GI tract findings in patients with heartburn in whom proton pump inhibitor treatment failed versus those not receiving antireflux treatment
AU - Poh, Choo Hean
AU - Gasiorowska, Anita
AU - Navarro-Rodriguez, Tomas
AU - Willis, Marcia R.
AU - Hargadon, Deborah
AU - Noelck, North
AU - Mohler, Jane
AU - Wendel, Christopher S.
AU - Fass, Ronnie
N1 - Funding Information:
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.
PY - 2010/1
Y1 - 2010/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=73249149648&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=73249149648&partnerID=8YFLogxK
U2 - 10.1016/j.gie.2009.08.024
DO - 10.1016/j.gie.2009.08.024
M3 - Article
C2 - 19922918
AN - SCOPUS:73249149648
SN - 0016-5107
VL - 71
SP - 28
EP - 34
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 1
ER -