A PPI test does not improve diagnosis of GERD
Clinical Question
Is a response to a proton pump inhibitor a useful diagnostic strategy to determine gastroesophageal reflux?
Bottom Line
Of patients who present with typical reflux symptoms, 70% will actually have gastroesophageal reflux disease (GERD). A 2-week trial to determine the response to a proton pump inhibitor (PPI) will not identify a significant proportion of patients who have true GERD. If a patient has typical reflux symptoms, begin treatment, since an early lack of response does not rule out true GERD. (LOE = 1c)
Reference
Aanen MC, Weusten BL, Numans ME, De Wit NJ, Baron A, Smout AJ. Diagnostic value of the proton pump inhibitor test for gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther 2006;24:1377-1384. [PMID:17059519]
Study Design
Diagnostic test evaluation
Funding
Industry
Setting
Outpatient (primary care)
Synopsis
A short course of a PPI is often used to determine whether a patient with typical reflux symptoms truly has GERD. To evaluate the diagnostic accuracy of the PPI test, the researchers enrolled 74 patients (average age = 51 years) with typical reflux symptoms. Approximately 1 in 5 patients smoked and 74% drank alcohol. Following 24-hour esophageal pH monitoring, all 74 patients then took esomeprazole 40 mg (Nexium) for 2 weeks, recording daily whether symptoms were suppressed. A positive response to the PPI test was considered to be a symptom association probability less than 95%, a symptom index of less than 50%, and a symptom severity index of less than 10%. These various outcomes are commonly used to evaluate GERD. The prevalence of GERD was 70% using the symptom association probability score, meaning that 70% of patients with refluxlike symptoms had GERD. The sensitivity of the PPI test was 91% (95% CI, 78%-96%) and the specificity was 26% (10%-49%). In this high prevalence population, the positive predictive value was 75% (62%-85%) and the negative predictive value was 54% (22%-81%). Using these results, the likelihood ratio for the PPI test was 1.2, similar to the likelihood ratio for the presence of typical symptoms.
Citation
Barry, Henry, et al., editors. "A PPI Test Does Not Improve Diagnosis of GERD." EE+ POEM Archive, John Wiley & Sons, 2024. Evidence Central, evidence.unboundmedicine.com/evidence/view/infoPOEMs/426650/all/A_PPI_test_does_not_improve_diagnosis_of_GERD.
A PPI test does not improve diagnosis of GERD. In: Barry HH, Ebell MHM, Shaughnessy AFA, et al, eds. EE+ POEM Archive. John Wiley & Sons; 2024. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426650/all/A_PPI_test_does_not_improve_diagnosis_of_GERD. Accessed December 8, 2024.
A PPI test does not improve diagnosis of GERD. (2024). In Barry, H., Ebell, M. H., Shaughnessy, A. F., & Slawson, D. C. (Eds.), EE+ POEM Archive. John Wiley & Sons. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426650/all/A_PPI_test_does_not_improve_diagnosis_of_GERD
A PPI Test Does Not Improve Diagnosis of GERD [Internet]. In: Barry HH, Ebell MHM, Shaughnessy AFA, Slawson DCD, editors. EE+ POEM Archive. John Wiley & Sons; 2024. [cited 2024 December 08]. Available from: https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426650/all/A_PPI_test_does_not_improve_diagnosis_of_GERD.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - A PPI test does not improve diagnosis of GERD
ID - 426650
ED - Barry,Henry,
ED - Ebell,Mark H,
ED - Shaughnessy,Allen F,
ED - Slawson,David C,
BT - EE+ POEM Archive
UR - https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426650/all/A_PPI_test_does_not_improve_diagnosis_of_GERD
PB - John Wiley & Sons
DB - Evidence Central
DP - Unbound Medicine
ER -