The Role of Esophageal pH Monitoring in Symptomatic Patients on PPI Therapy

Charbel, Samer; Khandwala, Farah; Vaezi, Michael F.

doi:10.1111/j.1572-0241.2005.41210.x

Cited by 201 publications

(147 citation statements)

References 15 publications

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“…Among refractory GERD patients with a negative refl ux monitoring study, those with heartburn may be classifi ed as having " functional heartburn " while those with extraesophageal symptoms (asthma, cough, laryngitis) will need additional acid exposure in 96 % of patients with refractory GERD that were tested on twice daily PPI ( 154 ). Although rare, an abnormal pH test in a patient taking a PPI (i.e.…”

Section: Summary Of the Evidencementioning

confidence: 99%

Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease

Katz¹,

Gerson²,

Vela³

2013

American Journal of Gastroenterology

1,534

1,430

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Section: Summary Of the Evidencementioning

confidence: 99%

Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease

Katz¹,

Gerson²,

Vela³

2013

American Journal of Gastroenterology

1,534

1,430

View full text Add to dashboard Cite

“…Measuring acid reflux by conventional pH monitoring in patients with acid suppression is not adequate because of the very low pretest likelihood of a positive test in this setting [Charbel et al 2005]. Combined MII and pH testing represents a better tool under these circumstances because it detects both acid and nonacid reflux.…”

Section: Functional Heartburn and Hypersensitive Esophagusmentioning

confidence: 99%

Selective-serotonin reuptake inhibitors for the treatment of hypersensitive esophagus

Viazis

Karamanolis

Vienna

et al. 2011

Therap Adv Gastroenterol

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In patients with proton-pump inhibitor (PPI) resistant reflux symptoms, ambulatory 24 h pH impedance monitoring can be used to assess whether a relationship exists between symptoms and reflux episodes. Using this technique it has been suggested that patients with typical reflux symptoms and a normal upper endoscopy should be subclassified as follows: normal endoscopy and abnormal distal acid esophageal exposure (patients with acid reflux); normal endoscopy, with normal distal acid esophageal exposure and a positive symptom association for either acid or nonacid reflux (patients with hypersensitive esophagus); and normal endoscopy, normal distal acid esophageal exposure and a negative symptom association for acid and nonacid reflux (patients with functional heartburn). Although for patients with a normal endoscopy and abnormal distal acid esophageal exposure more aggressive acid suppression can be recommended, managing patients with hypersensitive esophagus and functional heartburn remains a real challenge.Therefore, investigators have evaluated the role of tricyclic antidepressants or selectiveserotonin reuptake inhibitors (SSRIs) in influencing esophageal perception. Imipramine has been shown to decrease pain perception in healthy male volunteers and improve symptoms of patients with chest pain and normal coronary angiograms. Trazodone improved symptoms in patients with esophageal contraction abnormalities, while administration of SSRIs lowered chemical and mechanical sensitivity and benefited patients with diffuse esophageal spasm. Furthermore, in a recent study conducted by our group, citalopram administered once daily for 6 months was effective in a select group of patients with hypersensitive esophagus, suggesting that there is a role for SSRIs in the treatment of this disorder.

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“…PPIs have been reported to reduce the bioavailability of drugs up to 50%, and they can alter drug metabolism by induction or inhibition of the cytochrome P 450 enzymes, particularly in patients taking medications with a narrow therapeutic window (diazepam, phenytoin and warfarin) (27,65). The PPIs with greater potential for drug-drug interactions are omeprazole, esomeprazole and lansoprazole; pantoprazole has a lower potential for drug interactions (66). The decreased metabolism of CYP2C19 substrates is related primarily to omeprazole and esomeprazole.…”

Section: Drug-drug Interactionsmentioning

confidence: 99%

Proton pump inhibitors in gastroesophageal reflux disease: a custom-tailored therapeutic regimen

Sobrino-Cossío

López-Alvarenga

Remes-Troche

et al. 2012

Rev. esp. enferm. dig.

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The Montreal Definition and Classification divides Gastroesophageal Reflux Disease (GERD) into esophageal symptomatic syndromes (and with mucosal damage) and extraesophageal syndromes (with acid established association and proposed association). In typical GERD symptoms, an 8-week treatment with PPIs is satisfactory in most cases (> 90%). Response rates to PPIs in GERD are highly variable, as they also rely on an appropriate clinical diagnosis of the disease; endoscopy differentiates the macroscopic GERD phenotype. The non-erosive variety (50-70% prevalence) has a different symptomatic response rate, as gastric acid is not the sole etiology of symptoms. The possible explanations of treatment failure include treatment adherence, PPI metabolism alterations and characteristics, and inadequate diagnosis. Refractory symptoms are related to gastric content neutralization by the chronic use of PPIs.Extraesophageal manifestations are associated with other pathophysiological mechanisms where an autonomic nervous system disturbance gives rise to symptoms. In these clinical entities, the relationship between symptoms and acid needs to be established in order to determine the use of PPIs, or consider other drugs. In other words, so as to "custom-tailor the best-fitting therapy" we need to answer the questions for whom, for what, how and for how long. Finally, PPI safety and tolerability are factors to be considered in elderly patients requiring chronic PPI use, who usually have chronic concomitant illnesses.

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The Role of Esophageal pH Monitoring in Symptomatic Patients on PPI Therapy

Abstract: 1) The likelihood of an abnormal esophageal pH for symptomatic GERD patients on b.i.d. PPI is very small. 2) In this group of patients failing b.i.d. PPIs causes other than GERD should be sought.

Cited by 201 publications

References 15 publications

Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease

Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease

Selective-serotonin reuptake inhibitors for the treatment of hypersensitive esophagus

Proton pump inhibitors in gastroesophageal reflux disease: a custom-tailored therapeutic regimen

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