Clinical and Economic Assessment of the Omeprazole Test in Patients With Symptoms Suggestive of Gastroesophageal Reflux Disease

Abstract

Objective: To evaluate the diagnostic accuracy of a trial of a high-dose proton pump inhibitor (the omeprazole test) in detecting gastroesophageal reflux disease (GERD) in patients with heartburn symptoms.Design: A randomized, double-blind, placebocontrolled, crossover trial.Patients and Setting: Forty-three consecutive patients with symptoms suggestive of GERD were enrolled at a Veterans Affairs medical center.Main Outcome Measures: Symptom response to the omeprazole test vs placebo in GERD-positive and GERDnegative patients; sensitivity, specificity, and positive and negative predictive values of the omeprazole test; and cost per correct diagnosis achieved with the omeprazole test compared with traditional diagnostic strategies.Results: Of 42 patients (98%) who completed the study, 35 (83%) were classified as GERD positive and 7 (17%) as GERD negative. Twenty-eight GERD-positive and 3 GERD-negative patients responded to the omeprazole test, providing a sensitivity of 80.0% (95% confidence interval, 66.7%-93.3%) and a specificity of 57.1% (95% confidence interval, 20.5%-93.8%). Economic analysis revealed that the omeprazole test saves $348 per average patient evaluated, and results in a 64% reduction in the number of upper endoscopies performed and a 53% reduction in the use of pH testing. Conclusions:The omeprazole test is sensitive and fairly specific for diagnosing GERD in patients with typical GERD symptoms. This strategy could result in significant cost savings and decreased use of invasive diagnostic tests.

Symptoms of gastro‐oesophageal reflux disease and the severity of obstructive sleep apnoea syndrome are not related in sleep disorders center patients

“…11 For example, two studies revealed that 22 and 26% of patients with upper endoscopy documented erosive oesophagitis manifested normal 24-h pH probe test results. 12,13 Finally, in clinical practice the 24-h pH probe is not indicated for the routine evaluation of GERD but instead for the diagnosis of atypical symptomatology and for the assessment of subjects considering antireflux surgery. 14 Upper endoscopy also suffers flaws as a tool for diagnosing GERD.…”

Step-Down Management Of Gastroesophageal Reflux Disease

“…Specifically, these patients were not found to have evidence of either peptic ulcer or GERD after having undergone upper endoscopy, 24-hour ambulatory pH monitoring, and a therapeutic trial of high-dose PPI therapy. 26 Although not included as "successes" in our final analysis, it further illustrated the usefulness of a disease-oriented pharmacy clinic to optimally manage GERD patients. The use of nonphysicians to implement clinical practice guidelines was unique as it applied to this setting of reflux patients.…”

What is the place of empirical proton pump inhibitor testing in the diagnosis of gastroesophageal reflux disease? (Description, duration, and dosage)

“…Questionnaires and symptom records were used in most studies for the assessment of PPI response; although the symptom response threshold varied according to the study, in comparison with the beginning of the test, a 50%-75% recovery in symptoms was acceptable. A significant difference was not detected among PPIs in terms of effectiveness (10-12).Although the sensitivity of the PPI test is 27%-89% in patients with typical symptoms of GERD, its specificity is 35%-83% (2,(4)(5)(6)(7)(8)13,14). Because of the use of different methods and populations in studies, it is quite difficult to make comparisons.…”

“…Although the sensitivity of the PPI test is 27%-89% in patients with typical symptoms of GERD, its specificity is 35%-83% (2,(4)(5)(6)(7)(8)13,14). Because of the use of different methods and populations in studies, it is quite difficult to make comparisons.…”