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

Abstract

In routine clinical practice, empirical acid suppression tests that are performed with proton pump inhibitors (PPI) are used to detect the presence of acid-related upper gastrointestinal (GI) symptoms and GERD (1). Empirical PPI test is usually called as the "PPI test. "" Its first diagnostic use in patients with GERD was in 1995 (2). In comparison to other diagnostic methods for the diagnosis of GERD, it is non-invasive, easily applicable, and cost-effective. It can also be used for diagnostic purposes in patients with NCCP in addition to typical reflux symptoms. Mostly, high doses were used in the studies performed as a PPI test using omeprazole, esomeprazole, lansoprazole, and rabeprazole (2-12). 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. Similarly, because different PPIs were used in the PPI test studies and the durations were also different, an optimal dose or duration could not be determined through meta-analyses or systematic reviews; however, the duration was determined as 7-14 days in most studies (3). Some of the PPI test studies were performed comparatively only with upper gastrointestinal endoscopy or 24h pH monitoring. The symptoms are associated with GERD in 60% of the NCCP cases, and the response to the treatment is fairly good (15)(16)(17). Although the sensitivity of the PPI test is 69%-95% in patients with GERD-related NCCP in different studies, its specificity is 67%-86% (3,9,10,18,19). ABSTRACTEmpirical acid suppression tests that are performed with proton pump inhibitors (PPI) are used to detect both the presence of acid-related gastrointestinal symptoms and gastroesophageal reflux disease (GERD). In comparison to other diagnostic methods, it is non-invasive, easily applicable, and cost-effective in the diagnosis of GERD. In addition to typical reflux symptoms, it can also be used for diagnostic purposes in patients with non-cardiac chest pain (NCCP). If the symptom response is 50% and above when obtained using the PPI test in patients with NCCP, it can be considered as positive and the treatment should be continued sensitivity of the PPI test in patients with typical symptoms of GERD is 27%-89%, while its specificity is 35%-83%. Although there are differences related to the duration and dosage of the PPI test, a significant difference has not been found according to the type of PPI. When PPI test sensitivity and specificity were calculated by cumulatively evaluating the data regarding the PPI test in the literature, a sensitivity of 82....

The role of oesophageal physiological testing in the assessment of noncardiac chest pain

“…The PPI test has been shown to have a sensitivity and specificity of up to 89% and 53% respectively. 15,16 Controlled studies show that 52-95% of patients with proven GORD report improvement of chest pain symptoms compared with 10-50% of patients offered placebo. 15,17,18 Endoscopy is often the next test required.…”

Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-types of Gastroesophageal Reflux Disease and Gastroesophageal Reflux Disease-related Disorders

“…7,8 Current diagnostic methods for GERD include symptom questionnaires and 24-hour pH monitoring, 9 high-resolution esophageal manometry, 10 endoscopy, radionuclide gastroesophageal reflux test, and proton pump inhibitor (PPI) diagnostic treatments. 11 Among them, 24-hour pH monitoring is the most commonly used method with a high specificity. However, it is an invasive procedure, and associated with disadvantages such as poor patient tolerance, high cost, and difficulty in carrying out in primary hospitals.…”