Thirty to 50 percent of patients diagnosed with gastroesophageal reflux disease (GERD) are not satisfied with symptom control derived from proton pump inhibitors (PPI). This group of patients;PPI non-responders (PPI- NR), pursue further diagnostic procedures and interventions with low yield. This approach is problematic because symptoms are not related to pathologic reflux in at least 50% of PPI-NRs referred for ambulatory reflux testing and therefore it does not lead to improved outcomes or even inform us as to why a patient did not respond to PPI. The development of novel therapies for this group is limited by lack of agreement on the definition of a PPI responder and the lack of a model that accounts for the heterogeneity of continued symptom generation. Our goal is to validate a PPI-NR model that accounts for factors above and beyond pathologic reflux, reducing the need for low-yield ambulatory reflux monitoring and informing the development of novel treatments. Study 1 will provide an equation in which pre-test clinical and questionnaire data sufficiently enables probability estimation for each of 4 reflux phenotypes, derived from ambulatory reflux monitoring. Study 2 will yield a similar equation which will predict one's ability to withdraw PPI therapy when indicated.
Gastroesophageal reflux disease (GERD) is an increasingly common medical condition affecting at least ten percent of the adult US population. Despite the fact that proton pump inhibitors (PPI) are extremely effective, up to 30-50% of patients are unsatisfied with their response and continue to have refractory symptoms. This proposal seeks to identify the reason for continued symptoms and to determine whether a systematic diagnostic protocol will better define treatment strategies for PPI non-responders.
|Sodikoff, J B; Lo, A A; Shetuni, B B et al. (2016) Histopathologic patterns among achalasia subtypes. Neurogastroenterol Motil 28:139-45|
|Teitelbaum, Ezra N; Sternbach, Joel M; El Khoury, Rym et al. (2016) The effect of incremental distal gastric myotomy lengths on EGJ distensibility during POEM for achalasia. Surg Endosc 30:745-50|
|Kia, Leila; Pandolfino, John E; Kahrilas, Peter J (2016) Biomarkers of Reflux Disease. Clin Gastroenterol Hepatol 14:790-7|
|Riehl, M E; Pandolfino, J E; Palsson, O S et al. (2016) Feasibility and acceptability of esophageal-directed hypnotherapy for functional heartburn. Dis Esophagus 29:490-6|
|Kahrilas, P J; Keefer, L; Pandolfino, J E (2015) Patients with refractory reflux symptoms: What do they have and how should they be managed? Neurogastroenterol Motil 27:1195-201|
|Riehl, M E; Kinsinger, S; Kahrilas, P J et al. (2015) Role of a health psychologist in the management of functional esophageal complaints. Dis Esophagus 28:428-36|
|Riehl, Megan E; Keefer, Laurie (2015) Hypnotherapy for Esophageal Disorders. Am J Clin Hypn 58:22-33|
|Ravi, Karthik; Friesen, Laurel; Issaka, Rachel et al. (2015) Long-term Outcomes of Patients With Normal or Minor MotorÂ Function Abnormalities Detected by High-resolution Esophageal Manometry. Clin Gastroenterol Hepatol 13:1416-23|
|Roman, S; Keefer, L; Imam, H et al. (2015) Majority of symptoms in esophageal reflux PPI non-responders are not related to reflux. Neurogastroenterol Motil 27:1667-74|
|Yadlapati, Rena; Gawron, Andrew J; Bilimoria, Karl et al. (2015) Development of quality measures for the care of patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol 13:874-83.e2|
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