Reflux Monitoring Can Reduce the Inappropriate Use of Proton Pump Inhibitors in Patients With GERD

Proton pump inhibitors (PPIs) are the main treatment for gastroesophageal reflux disease (GERD). However, 30% to 50% of patients with GERD fail to achieve adequate symptom relief despite PPI therapy. Prolonged wireless reflux monitoring (pH testing) has been utilized to quantify esophageal acid exposure and assess GERD symptom associations, but the clinical use of reflux monitoring to guide management is unclear. This prospective clinical trial evaluated the clinical use of prolonged wireless reflux monitoring to predict the feasibility of discontinuing PPI therapy among patients with GERD and inadequate PPI response. 

A total of 100 patients (mean age, 48.6 years; 41 men; mean body mass index, 27.1 kg/m2) with GERD underwent ambulatory reflux monitoring for an average of 3.4 days after stopping PPI therapy. The primary outcome was PPI discontinuation, which was noted in 34 (34%) participants, whereas 66 (66%) participants resumed PPI therapy. During pH monitoring, the total acid exposure time (AET) was significantly higher in patients who resumed PPI therapy compared to those who discontinued PPIs (6.6%, with a standard deviation [SD] of 3.6, vs 4.3%, with an SD of 3.6; P<.01). The strongest predictor of PPI discontinuation was the number of days with AET >4.0%. The odds of discontinuing PPIs in participants with zero days of AET >4.0% was 10 times greater than that for participants with 4 days of  AET >4.0% (odds ratio [OR], 10.0; 95% confidence interval [CI], 2.70, 43.32; P<.01). Compared to patients who discontinued PPI therapy, patients who resumed PPI therapy had significantly higher mean baseline scores using the Reflux Symptom Questionnaire-electronic Diary (17.8 [SD, 11.7] vs 12.0 [SD, 9.6]; P=.02) and GerdQ (9.3 [SD, 4.6] vs 7.2 [SD, 3.0]; P=.01).