Does Symptom Response Diagnose Gastroesophageal Reflux Disease? FREE

Gastroesophageal reflux disease (GERD) is a backflow (reflux) of stomach contents into the esophagus. It happens when the valve between the esophagus and stomach opens or relaxes. The reflux of stomach contents causes symptoms such as heartburn, indigestion, and sour- or bitter-tasting fluids in the throat or mouth. Diagnosing GERD can be difficult because symptoms may be similar to those seen in other digestive disorders. Standard diagnostic tests include measuring the amount of stomach acid in the esophagus over a 24-hour period (pH monitoring), visually examining the esophagus by using an instrument passed through the mouth (endoscopy), or completing a checklist for GERD symptoms. Doctors often prescribe medicines called proton-pump inhibitors (PPIs) to reduce stomach acid and symptoms of GERD. They sometimes assume that a patient has GERD if the PPIs eliminate symptoms. Is this assumption correct?

To compare patients' responses to short-term treatment with a PPI as a diagnostic test with other, more established procedures for diagnosing GERD.

More than 2750 patients with suspected GERD who took PPIs and also had tests for GERD.

Rather than doing a new study, the authors searched the medical literature from January 1980 through July 2003. They found 15 studies that involved patients with suspected GERD who received PPI treatment. Treatment with a PPI was short-term, lasting from 1 to 4 weeks. All of the patients also received tests for GERD, including pH monitoring, endoscopy, or standardized questionnaires. The researchers combined the results of the studies to see whether patients whose symptoms improved with PPI treatment had GERD and whether patients whose symptoms did not improve with PPI treatment did not have GERD.

About 50% to 70% of the patients in the studies reported that PPIs reduced symptoms. Tests, such as pH monitoring and endoscopy, showed that many of these patients did not have GERD. Also, about 20% to 40% of the patients who had positive test results for GERD reported that PPIs did not reduce symptoms.

Studies defined “successful” reduction of GERD symptoms differently. Also, there was too little information with which to evaluate whether different doses of PPIs and length of treatment with PPIs made a difference in diagnosing GERD.

Symptomatic response to short-term treatment with a PPI does not confidently diagnose GERD.