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Observational Study
. 2018 Jan;113(1):31-38.
doi: 10.1038/ajg.2017.263. Epub 2017 Sep 12.

Psychosocial Distress and Quality of Life Impairment Are Associated With Symptom Severity in PPI Non-Responders With Normal Impedance-pH Profiles

Rena Yadlapati  1 , Michael Tye  2 , Laurie Keefer  3 , Peter J Kahrilas  2 , John E Pandolfino  2
Affiliations
Observational Study

Psychosocial Distress and Quality of Life Impairment Are Associated With Symptom Severity in PPI Non-Responders With Normal Impedance-pH Profiles

Rena Yadlapati et al. Am J Gastroenterol. 2018 Jan.

Abstract

Objectives: Up to 50% of patients with reflux symptoms do not manifest a satisfactory symptom response to proton pump inhibitor (PPI) therapy. Our primary aim in this study was to identify factors associated with symptom perception among PPI non-responder phenotypes.

Methods: This prospective observational cohort study was performed from September 2014 to January 2017 at a single academic medical center and included PPI non-responders who underwent 24-h impedance-pH monitoring and completed a questionnaire set measuring patient-reported symptom severity, quality of life (QOL), and psychosocial distress. Participants were separated into cohorts based on impedance-pH results: on PPI: -acid exposure time (AET)/-symptom-reflux association (SRA), +AET, and -AET/+SRA; off PPI: functional (-AET/-SRA), gastroesophageal reflux disease (GERD) (+AET), and reflux hypersensitivity (RHS) (-AET/+SRA). The primary outcome was abnormal GERD symptom severity defined by GerdQ≥8.

Results: One hundred and ninety-two participants were included. Impedance-pH on PPI was performed on 125: 72 (58%) -AET/-SRA, 42 (34%) +AET, and 11 (9%) -AET/+SRA. Among the -AET/-SRA group, younger age, higher dysphagia scores, QOL impairment, and higher brief symptom index were associated with GerdQ≥8. Among the +AET group, higher number of reflux-associated symptoms and lower distal contractile integral was associated with GerdQ≥8. Impedance-pH off PPI was performed on 67 participants: 39 (58%) functional, 16 (24%) GERD, and 12 (18%) RHS. Among the functional group, higher QOL impairment and dysphagia scores were seen with GerdQ≥8.

Conclusions: Perceptions of reflux symptoms are associated with psychosocial distress, reduced QOL, and sensation of dysphagia among PPI non-responders with normal impedance-pH. Among PPI refractory GERD patients, patient-reported symptom severity is associated with physiological differences, as opposed to psychosocial factors.

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Conflict of interest statement

Potential Conflict of Interest (Financial, Professional or Personal): None

Figures

Figure 1
Figure 1
Questionnaire scores by symptom severity according to PPI non-responder profile. Among functional (+/− GERD overlap), symptom severity is associated with a higher IDQ score and QOL score. * p<0.05, † p<0.10
Figure 2
Figure 2
Physiologic data by symptom severity according to PPI non-responder profile. Among PPI refractory GERD patients, symptom severity is associated with number of reflux associated symptoms and a lower distal contractile integral. * p<0.05, † p<0.10
See this image and copyright information in PMC

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