A recent prospective study (J Abdallah et al. Clin Gastroenterol Hepatol 2019; 17: 1073-80) examined adults patients with documented reflux at baseline.  Patients who reported heartburn and/or regurgitation at least twice a week for 3 months (n=16) despite proton pump inhibitor (PPI) therapy were considered PPI failures. Those (n=13) who responded to standard dose PPI for at least 4 weeks were in the “PPI success” group.

Standard PPI dosing in this study:

• Omeprazole 20 mg per day
• Esomeprazole 40 mg per day
• Pantoprazole 40 mg per day

Methods: Both groups (PPI Failure group, PPI Success group) underwent EGD and pH-MII studies. Abnormal acid exposure was considered if pH <4 was present for >4.2%.

Key findings:

• 12 patients (75%) in the PPI failure group had either functional heartburn or reflux hypersensitivity
• 4 patients in both groups had abnormal pH test result.
• There was no statistically significant differences in the number of reflux events, acid exposure or nonacid reflux parameters between patients who failed or those who were successfully treated with PPIs.
• In the PPI failure group: 25% had persistent GERD, 12.% had overlap with reflux hypersensitivity, and 62.5% had overlap with functional heartburn

My take: The difference between PPI failure and PPI success largely is due to the overlapping presence of functional esophageal disorders.

Related blog posts:

• How Many Kids with Reflux Actually Have Reflux?
• Why didn’t patient with documented reflux get better with PPI …
• Failure of PPI test | gutsandgrowth
• Guidelines on Functional Heartburn
• Better to do a coin toss than an ENT exam to determine reflux
• How Likely is Reflux in Infants with “Reflux-like … – gutsandgrowth
• PPI Webinar
• The Connection Between Anxiety and Gastroesophageal Reflux Disease

Royal Palace, Madrid