Predicting Partial Response to PPI Therapy

As nearly one-third of patients with gastroesophageal reflux disease (GERD) are partial responders to proton pump inhibitor (PPI) therapy, health care professionals could benefit from reliable methods that predict who will respond to PPIs and who will not.

To date, studies have suggested that disease duration, obesity, delayed gastric emptying, comorbidities like irritable bowel syndrome or dyspepsia, and esophageal hypersensitivity cause or contribute to partial response to PPIs. Now, a study that appeared in the October 2014 issue of BMC Gastroenterology suggests symptom severity cannot be used to predict PPI response.

Researchers at the University of Wisconsin School of Medicine and Public Health conducted a post-hoc analysis of data from 2 studies. The first examined the symptom profiles of 580 GERD patients who experienced heartburn and/or regurgitation more than 3 times a week despite PPI therapy, while the second looked at 203 similar patients who were treatment-naïve.

PPI responders and treatment-naïve patients with GERD reported similar symptom patterns. Regardless of the study in which they enrolled, all patients identified reflux, indigestion, and abdominal pain as their most severe symptoms.

Partial PPI responders had more severe heartburn and regurgitation, which they reported as their main symptom burden. They also experienced more constipation while receiving PPI therapy than the treatment-naïve patients.

Although previous studies have hinted at an association between constipation and reflux disease, they were unable to determine a pathophysiological explanation. In this study, partial responders had longer GERD durations than treatment-naïve patients.

The authors noted that treatment with reflux inhibitors such as baclofen and some experimental drugs might be possible alternatives to PPI therapy when partial responders have persistent reflux. They concluded that partial PPI responders and untreated patients with GERD have similar symptom profiles, so it is unlikely that clinicians can predict which patients will respond to PPIs based on symptoms alone.