TY - JOUR
T1 - Psychosocial distress and quality of life impairment are associated with symptom severity in PPI non-responders with normal impedance-pH profiles
AU - Yadlapati, Rena
AU - Tye, Michael
AU - Keefer, Laurie
AU - Kahrilas, Peter J.
AU - Pandolfino, John E.
N1 - Funding Information:
R.Y. was supported by the Public Health Service NIH T32DK101363 (JEP). J.E.P. was supported by the Public Health Service NIH R01DK092217 (JEP).
Funding Information:
Guarantor of the article: Rena Yadlapati, MD, MSHS. Specific author contributions: Study oversight; study concept and design; acquisition of data; analysis and interpretation of data; drafting of manuscript; critical revision of the manuscript for important intellectual content; finalization of manuscript: Rena Yadlapati; study concept and design; acquisition of data; analysis and interpretation of data; critical revision of the manuscript for important intellectual content; finalization of manuscript: Michael Tye; acquisition of data; interpretation of data; critical revision of the manuscript for important intellectual content; finalization of manuscript: Laurie Keefer; interpretation of data; critical revision of the manuscript for important intellectual content; finalization of manuscript: Peter J. Kahrilas; study concept and design; analysis and interpretation of data; drafting of manuscript; critical revision of the manuscript for important intellectual content; finalization of manuscript: John E. Pandolfino. Financial support: R.Y. was supported by the Public Health Service NIH T32DK101363 (JEP). J.E.P. was supported by the Public Health Service NIH R01DK092217 (JEP). Potential competing interests: None.
Publisher Copyright:
© 2018 by the American College of Gastroenterology.
PY - 2018
Y1 - 2018
N2 - Objectives: Up to 50% of patients with reflux symptoms do not manifest a satisfactory symptom response to proton pump inhibitor (PPI) therapy. Our primary aim in this study was to identify factors associated with symptom perception among PPI non-responder phenotypes. Methods: This prospective observational cohort study was performed from September 2014 to January 2017 at a single academic medical center and included PPI non-responders who underwent 24-h impedancepH monitoring and completed a questionnaire set measuring patient-reported symptom severity, quality of life (QOL), and psychosocial distress. Participants were separated into cohorts based on impedance-pH results: on PPI: -acid exposure time (AET)/-symptom-reflux association (SRA), +AET, and -AET/+SRA; off PPI: functional (-AET/-SRA), gastroesophageal reflux disease (GERD) (+AET), and reflux hypersensitivity (RHS) (-AET/+SRA). The primary outcome was abnormal GERD symptom severity defined by GerdQ≥8. RESULTS: One hundred and ninety-two participants were included. Impedance-pH on PPI was performed on 125: 72 (58%) -AET/-SRA, 42 (34%) +AET, and 11 (9%) -AET/+SRA. Among the -AET/-SRA group, younger age, higher dysphagia scores, QOL impairment, and higher brief symptom index were associated with GerdQ≥8. Among the +AET group, higher number of reflux-associated symptoms and lower distal contractile integral was associated with GerdQ≥8. Impedance-pH off PPI was performed on 67 participants: 39 (58%) functional, 16 (24%) GERD, and 12 (18%) RHS. Among the functional group, higher QOL impairment and dysphagia scores were seen with GerdQ≥8. Conclusions: Perceptions of reflux symptoms are associated with psychosocial distress, reduced QOL, and sensation of dysphagia among PPI non-responders with normal impedance-pH. Among PPI refractory GERD patients, patient-reported symptom severity is associated with physiological differences, as opposed to psychosocial factors.
AB - Objectives: Up to 50% of patients with reflux symptoms do not manifest a satisfactory symptom response to proton pump inhibitor (PPI) therapy. Our primary aim in this study was to identify factors associated with symptom perception among PPI non-responder phenotypes. Methods: This prospective observational cohort study was performed from September 2014 to January 2017 at a single academic medical center and included PPI non-responders who underwent 24-h impedancepH monitoring and completed a questionnaire set measuring patient-reported symptom severity, quality of life (QOL), and psychosocial distress. Participants were separated into cohorts based on impedance-pH results: on PPI: -acid exposure time (AET)/-symptom-reflux association (SRA), +AET, and -AET/+SRA; off PPI: functional (-AET/-SRA), gastroesophageal reflux disease (GERD) (+AET), and reflux hypersensitivity (RHS) (-AET/+SRA). The primary outcome was abnormal GERD symptom severity defined by GerdQ≥8. RESULTS: One hundred and ninety-two participants were included. Impedance-pH on PPI was performed on 125: 72 (58%) -AET/-SRA, 42 (34%) +AET, and 11 (9%) -AET/+SRA. Among the -AET/-SRA group, younger age, higher dysphagia scores, QOL impairment, and higher brief symptom index were associated with GerdQ≥8. Among the +AET group, higher number of reflux-associated symptoms and lower distal contractile integral was associated with GerdQ≥8. Impedance-pH off PPI was performed on 67 participants: 39 (58%) functional, 16 (24%) GERD, and 12 (18%) RHS. Among the functional group, higher QOL impairment and dysphagia scores were seen with GerdQ≥8. Conclusions: Perceptions of reflux symptoms are associated with psychosocial distress, reduced QOL, and sensation of dysphagia among PPI non-responders with normal impedance-pH. Among PPI refractory GERD patients, patient-reported symptom severity is associated with physiological differences, as opposed to psychosocial factors.
UR - http://www.scopus.com/inward/record.url?scp=85046138369&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85046138369&partnerID=8YFLogxK
U2 - 10.1038/ajg.2017.263
DO - 10.1038/ajg.2017.263
M3 - Article
C2 - 28895583
AN - SCOPUS:85046138369
SN - 0002-9270
VL - 113
SP - 31
EP - 38
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 1
ER -