Concomitant Symptoms Itemized in the Reflux Disease Questionnaire Are Associated With Attenuated Heartburn Response to Acid Suppression

Kahrilas, Peter J.; Jönsson, Andreas; Denison, Hans; Wernersson, Börje; Hughes, Nesta; Howden, Colin W.

doi:10.1038/ajg.2012.197

Cited by 16 publications

(9 citation statements)

References 17 publications

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“…However, this study demonstrated approximately a quarter of patients with GORD still had frequent regurgitation, despite heartburn relief. This is in line with the findings of two other studies derived from this dataset5 6 reporting that the responsiveness of individual GORD symptoms was not equivalent and that regurgitation was not as responsive as heartburn to potent acid suppression. These data suggest that persistent regurgitation may be a relatively common characteristic of patients with GORD who do not respond fully to therapy.…”

Section: Discussionsupporting

confidence: 92%

“…However, a recent systematic review4 and a retrospective analysis of data from two large GORD clinical trials (conducted using the same dataset as this study)5 suggest that regurgitation typically responds less well than heartburn to acid suppression. These two GORD trials used the Reflux Disease Questionnaire (RDQ) to characterise upper gastrointestinal symptoms and found that the average study subject endorsed four of the six RDQ items with some severity and that the response of heartburn (substernal burning behind the breastbone) was diminished by the presence of concomitant symptoms (particularly dyspepsia) at the start of treatment 6. Another limitation of existing clinical data pertains to the impact of persistent symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Impact of regurgitation on health-related quality of life in gastro-oesophageal reflux disease before and after short-term potent acid suppression therapy

Kahrilas

Jönsson

Denison

et al. 2013

Gut

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Objective Limited data exist on the impact of regurgitation on health-related quality of life (HRQOL) in gastro-oesophageal reflux disease (GORD). We assessed the relationship between regurgitation frequency and HRQOL before and after acid suppression therapy in GORD. Method We used data from two randomised trials of AZD0865 25–75 mg/day vs. esomeprazole 20 or 40 mg/day in non-erosive reflux disease (NERD) (n=1415) or reflux oesophagitis (RO) (n=1460). The Reflux Disease Questionnaire was used to select patients with frequent and intense heartburn for inclusion and to assess treatment response. The Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire was used to assess HRQOL. Results At baseline, 93% of patients in both the NERD and RO groups experienced regurgitation. Mean QOLRAD scores were similar for NERD and RO at baseline and at week 4 and disclosed decremental HRQOL with increasing frequency of regurgitation; a clinically relevant difference of >0.5 in mean QOLRAD scores was seen with regurgitation ≥4 days/week vs. <4 days/week. The prevalence of frequent, persistent regurgitation (≥4 days/week) at week 4 among heartburn responders (≤1 day/week of mild heartburn) was 28% in NERD and 23% in RO. QOLRAD scores were higher amongst heartburn responders. There was a similar pattern of impact related to regurgitation frequency in heartburn responders as in the group as a whole. Conclusion Frequent regurgitation was associated with a clinically relevant, incremental decline in HRQOL beyond that associated with heartburn before and after potent acid suppression, in both NERD and RO. Clinical trial numbers NCT00206284 and NCT00206245.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Impact of regurgitation on health-related quality of life in gastro-oesophageal reflux disease before and after short-term potent acid suppression therapy

Kahrilas

Jönsson

Denison

et al. 2013

Gut

Self Cite

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“…Not surprisingly, higher pretreatment scores for dyspeptic symptoms predict poorer symptom response to PPI therapy [26]. In two large randomized trials using the Reflux Disease Questionnaire (RDQ) other concomitant RDQ items, particularly ‘substernal pain’ and ‘dyspepsia pain’ were associated with a reduced benefit of acid suppression for ‘substernal burning’ [27]. Finally, there are no specific data supporting the clinical use of questionnaires as a diagnostic test in patients with therapy-resistant GERD.…”

Section: Diagnostic Testsmentioning

confidence: 99%

Management of the patient with incomplete response to PPI therapy

Kahrilas

Boeckxstaens

Smout

2013

Best Practice & Research Clinical Gastroenterology

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Proton pump inhibitors (PPIs) remove most of the acid from the gastroesophageal refluxate. However, PPIs do not eliminate reflux and the response of specific GERD symptoms to PPI therapy depends on the degree to which acid drives those symptoms. PPIs are progressively less effective for heartburn, regurgitation, chest pain and extra-esophageal symptoms. Hence, with an incomplete PPI response, obtaining an accurate history, detailing which symptoms are ‘refractory’ and exactly what evidence exists linking these symptoms to GERD is paramount. Reflux can continue to cause symptoms despite PPI therapy because of persistent acid reflux or weakly acidic reflux. Given these possibilities, diagnostic testing (pH or pH-impedance monitoring) becomes essential. Antireflux surgery is an alternative in patients if a clear relationship is established between persistent symptoms, particularly regurgitation, and reflux. Treating visceral hypersensitivity may also benefit the subset of GERD patients whose symptoms are driven by this mechanism.

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“…Reflux Disease Questionnaire(44), UCLA SCTC GIT 2.0(5), Quality of Life in Reflux and Dyspepsia (QOLRAD)(45). …”

Section: Imaging Modalitiesmentioning

confidence: 99%

Measuring response in the gastrointestinal tract in systemic sclerosis

Khanna

Nagaraja

Gladue

et al. 2013

Current Opinion in Rheumatology

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Purpose of review Gastrointestinal tract (GIT) involvement in systemic sclerosis (scleroderma, SSc) is the most common internal complication. This review discusses the outcome measures to measure GIT involvement in clinical care and trials. Recent findings Patient-reported outcome measures have been validated (UCLA SCTC GIT 2.0 and NIH PROMIS® scales) in SSc-GIT. Multiple objective measures are available to assess mucosal involvement and motility in GIT. However, these need to validated in SSc for trials. Summary GIT is a common cause of morbidity and has negative impact on quality of life in SSc. Recommendations are given for trial design and evaluation of GI involvement in SSc.

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Concomitant Symptoms Itemized in the Reflux Disease Questionnaire Are Associated With Attenuated Heartburn Response to Acid Suppression

Cited by 16 publications

References 17 publications

Impact of regurgitation on health-related quality of life in gastro-oesophageal reflux disease before and after short-term potent acid suppression therapy

Impact of regurgitation on health-related quality of life in gastro-oesophageal reflux disease before and after short-term potent acid suppression therapy

Management of the patient with incomplete response to PPI therapy

Measuring response in the gastrointestinal tract in systemic sclerosis

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