The empiric treatment of uncomplica...

The empiric treatment of uncomplicated gastroesophageal ebb disease (GERD) with proton-pump inhibitors (PPI) and lifestyle changes has been endorsed by the agency of multiple medical organizations. The use of "the PPI test"--considering a rapid symptom reply to a normal dose as validation of the diagnosis--has been widely accepted. Studies confirming this image of diagnostic treatment trial, however, have been inconsistent. Clarification of the reliability of the PPI standard would be useful to avoid inappropriate long-term use of PPI treatment and misdiagnosis of GERD-like symptoms. Numans and associates used a meta-analysis of studies looking at answer to PPI treatment as a diagnostic proof for GERD when compared with standard objective testing.

Fifteen studies (including 2793 patients) of PPI treatment of presumptive GERD that also included objective testing with a structur symptom score, 24-hour pH monitoring, or endoscopy were included in the meta-analysis. fortunate symptom response to the PPI treatment demonstrated the highest positive likelihood association with objective GERD when the latter was defined on an abnormal 24-hour pH monitoring trial Using other standard reference touchstones the positive predictive value of answer to PPI was close to 10 which indicates poor reliability for the diagnosis of GERD

The authors end that a positive response to short-term PPI treatment does not reliably correspond to the diagnosis of GERD as defined from specific objective criteria. Patients with objectively determined GERD also may not correspond to normal-dose PPI therapy because of the ne for a higher dosage or a longer duration of treatment. Despite these accrues empiric PPI treatment for suspected, uncomplicated GERD might still be appropriate and might solve patient symptoms. The utility of long-term treatment in patients who answer to short-term empiric treatment straits to be individualized until better orders are developed to determine a diagnosis.

used by all Indications for Endoscopy

Clinical suggestions of morose reflux or other disease, including odynophagias, dysphagia, persistent or progressive symptoms upon therapy, immunosuppression, GI bleeding, weight los or noncardiac chest pain

Screening for Barrett's esophagus in high-risk patients (white men older than 50 years with chronic symptoms)

Abnormality onward esophagram

GI = gastrointestinal.

Information from van Pinxteren B Numans ME Bonis PA, Lau J Short-term treatment with proton cross-examine inhibitors, [H.sub.2]-receptor antagonists and prokinetics for gastro-oesophageal ebb disease-like symptoms and endoscopy negative ebb disease. (Cochrane Review). In: The Cochrane Library, Issue 2 2004 Chichester, UK: John Wiley & Son Ltd

Numans ME et al. Short-term treatment with proton-pump inhibitors as a exhibition for gastroesophageal reflux disease. Ann Intern M April 6 2004;140:518-27

EDITOR'S NOTE: The empiric use of PPIs in patients with symptoms of GERD is becom-ing standard. PPIs have been shown to be superior to [histamine.sub.2]-receptor antagonists in empiric treatment of typical GERD symp-toms, moreover not necessarily in the treatment of endoscopy-negative ebb disease. (1) In the latter dispose both drugs work equally well. mostly patients with heartburn show no endoscopic abnormalities, on the contrary empiric treatment with PPIs without endoscopy is still the principally cost-effective management strategy. Some of the more oft-repeated indications for endoscopy that have been attract favor toed by the Ameri-can Society for Gastrointestinal Endoscopy and/or the American community of Gastroenterology are noted in the accompanying table. If there is no relate to about other diagnoses, there is no evidence to support the use of routine endoscopy in patients with heart-burn who accord to medical therapy.

REFERENCE

(1) Van Pinxteren B Numans ME Bonis PA, Lau J Short-term treatment with proton interrogate inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal ebb disease-like symptoms and endoscopy negative ebb disease. (Cochrane Review). In: The Cochrane Library, Issue 2 2004 Chichester, UK: John Wiley & Son Ltd

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