Specific dyspeptic symptoms are associated with poor response to therapy in patients with gastroesophageal reflux disease

Abstract

Introduction: In patients with gastroesophageal reflux disease (GORD), co-existence of functional dyspepsia (FD) is known to be associated with poor response to proton pump inhibitors (PPIs), but the contribution of specific dyspepsia symptoms has not yet been systematically investigated.

Objective: We aimed to characterize the impact of dyspepsia symptoms on response to PPIs in patients with GORD.

Methods: The enrolled subjects were consecutive patients with a diagnosis of GORD. All patients underwent a 24 hour pH-impedance test, while on PPI therapy. Patients were divided into two groups, refractory and responders, according to the persistence of GORD symptoms. A standardized questionnaire for FD was also administered to assess presence of dyspepsia symptoms.

Results: In the subgroup of refractory patients FD was more prevalent than in responders, with post-prandial fullness, nausea, vomiting, early satiation and epigastric pain being significantly prevalent in refractory GORD patients. In the multivariate analysis only early satiation and vomiting were significantly associated with poor response to PPIs.

Conclusion: Co-existence of FD is associated with refractory GORD. We showed that only early satiation and vomiting are risk factors for poor response to therapy with PPIs. Our findings suggest that symptoms of early satiation and vomiting would help to identify the subset of PPI-refractory GORD patients.

Keywords: Refractory GERD; early satiation; functional dyspepsia; pH–impedance monitoring; proton pump inhibitors; vomiting.

Figure 1.

A – Prevalence of post-prandial fullness, nausea, vomiting, early satiation and epigastric pain was significantly higher in refractory (black) than in responder (white) GORD patients; no significant differences were found in prevalence of belching and bloating. B – The same data were found when only moderate–severe symptoms were considered (intensity score > 2).

Figure 2.

Epigastric pain, early satiation, nausea, vomiting, epigastric burning and post-prandial fullness were associated with a significantly lower response to PPIs, while bloating and belching did not interfere with PPI response in GORD patients.

Figure 3.

Multivariate analysis revealed that among all the dyspeptic symptoms, only vomiting and early satiation were risk factors significantly associated with poor response to PPIs in GORD patients.