Effect of proton-pump inhibitor treatment on symptoms and quality of life in GERD patients depends on the symptom-reflux association

Backgound: Gastroesophageal reflux disease patients demonstrate various pathophysiologic backgrounds. Therefore, a heterogeneous response to proton-pump inhibitor (PPI) treatment can be expected. We investigated the effect of short-term PPI treatment on symptoms and quality of life (QOL) in primary care patients with and without pathologic esophageal acid exposure and in presence or absence of a positive association between symptoms and reflux episodes.Study: Seventy-four heartburn patients were categorized into 4 groups according to positive or negative symptom-reflux association, as expressed in symptom index, symptom sensitivity index, and symptom association probability (SAP) and presence or absence of pathologic reflux, defined as esophageal pH <4%> 6% of the time (pH + /pH -). Overall and specific reflux symptoms were assessed 1 week before and the last week during a 2-week course of 40-mg esomeprazole daily. The QOL was scored by the Quality of Life in Reflux and Dyspepsia questionnaire 2 weeks before treatment and directly after.Results: Using the SAP to assess symptom-reflux associations, the 4 groups [SAP + pH + (n = 40); SAP + pH - (n = 12); SAP - pH + (n = 10); SAP - pH - (n = 10)] had similar demographic characteristics. The SAP - pH - subgroup had the least overall symptom reduction (P <0.01) and in the SAP + pH + subgroup the greatest heartburn symptom reduction was found (P <0.02). The residual symptom scores on treatment were lowest in SAP + pH + and highest in SAP - pH - subgroups and relatively high in the SAP+pH -. QOL was severely reduced and SAP - pH - patients had the lowest QOL overall. Similar findings were made using symptom index and symptom sensitivity index.Conclusions: Symptomatic reflux patients without evidence of reflux disease on a 24-hour pH recording responded less favorably to PPI treatment than patients with a positive symptom-reflux association or with pathologic reflux.