Evaluating the clinical efficacy of therapies in patients with symptoms of gastroesophageal reflux disease after phenotyping based on 24-h pH-impedance monitoring
https://doi.org/10.21518/ms2024-406
Abstract
Introduction. The inefficiency of proton pump inhibitors (PPIs) in patients with symptoms of gastroesophageal reflux disease (GERD) may be caused by functional esophageal diseases, which should be diagnosed by using pH-impedance monitoring.
Aim. To evaluate the clinical efficacy of therapies in patients with symptoms of gastroesophageal reflux disease after phenotyping based on 24-h pH-impedance monitoring.
Materials and methods. A total of 61 patients with GERD symptoms were observed in a prospective study. The patients were categorized into 3 phenotypes based on the Lyon Consensus 2.0 and Rome criteria IV: nonerosive reflux disease (NERD), hypersensitive esophagus (HSE), functional heartburn (FH). The 5-point Likert scale was used to measure the severity of symptoms. NERD patients received PPI (omeprazole 20 mg twice daily), HSE patients received PPI (omeprazole 20 mg twice daily) and a selective serotonin reuptake inhibitor (SSRI) (citalopram 20 mg daily), FH patients received tricyclic antidepressant (TCA) (amitriptyline ¼ tablet at the bedtime). The entire length of treatment in all groups was 4 weeks.
Results. The severity of heartburn in patients with NERD, HSE and FH before treatment averaged 3.23 (95% CI 3.02–3.43) points on the Likert scale (strong). Due to therapy, the average score in the NERD group decreased from 3.48 (95% CI 3.23–3.74) to 0.77 (95% CI 0.53–1.01), in the HSE group from 2.92 (95% CI 2.41–3.42) to 0.83 (95% CI 0.30–1.36), and in the FH group from 2.86 (95% CI 2.41–3.30) to 0.86 (95% CI 0.41–1.30). The efficacy of therapy in NERD patients was 85%. The efficacy of PPI + SSRI and TCA in patients with HSE and FH was 83% and 79%, respectively.
Conclusion. A differentiated approach to the treatment of patients with heartburn symptoms based on phenotyping using 24-h impedance-pH findings can help optimize the therapy and improve its efficiency.
About the Authors
I. V. Maev
Russian University of Medicine (ROSUNIMED)
Russian Federation
Russian Federation
Igor V. Maev, Acad. RAS, Dr. Sci. (Med.), Professor, Honoured Doctor of the Russian Federation, Honored Scientist of the Russian Federation, Head of the Department of Propaedeutics of Internal Diseases and Gastroenterology
20, Bldg. 1, Delegatskaya St., Moscow, 127473
M. A. Ovsepian
Russian University of Medicine (ROSUNIMED)
Russian Federation
Russian Federation
Mariia A. Ovsepian, Assistant of the Department of Propaedeutics of Internal Diseases and Gastroenterology, Researcher of the Laboratory of Functional Research Methods in Gastroenterology
20, Bldg. 1, Delegatskaya St., Moscow, 127473
D. N. Andreev
Russian University of Medicine (ROSUNIMED)
Russian Federation
Russian Federation
Dmitry N. Andreev, Cand. Sci. (Med.), Associate Professor of the Department of Propaedeutics of Internal Diseases and Gastroenterology, Researcher, Laboratory of Functional Research Methods in Gastroenterology
20, Bldg. 1, Delegatskaya St., Moscow, 127473
E. V. Barkalova
Russian University of Medicine (ROSUNIMED)
Russian Federation
Russian Federation
Elena V. Barkalova, Assistant of the Department of Propaedeutics of Internal Diseases and Gastroenterology, Head of the Laboratory of Functional Research Methods in Gastroenterology
20, Bldg. 1, Delegatskaya St., Moscow, 127473
R. I. Shaburov
Russian University of Medicine (ROSUNIMED); Central Clinical Hospital “RZD-Medicine”
Russian Federation
Russian Federation
Rafik I. Shaburov, Cand. Sci. (Med.), Assistant Professor of the Department of Propaedeutics of Internal Diseases and Gastroenterology; Chief Medical Officer
20, Bldg. 1, Delegatskaya St., Moscow, 127473
2, Budayskaya St., Moscow, 129128
L. A. Tararina
Russian University of Medicine (ROSUNIMED)
Russian Federation
Russian Federation
Larisa A. Tararina, Senior Lecturer of the Department of Pharmacology, Junior Researcher of the Laboratory of Functional Research Methods in Gastroenterology
20, Bldg. 1, Delegatskaya St., Moscow, 127473
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For citations:
Maev IV, Ovsepian MA, Andreev DN, Barkalova EV, Shaburov RI, Tararina LA. Evaluating the clinical efficacy of therapies in patients with symptoms of gastroesophageal reflux disease after phenotyping based on 24-h pH-impedance monitoring. Meditsinskiy sovet = Medical Council. 2024;(15):22–29. (In Russ.) https://doi.org/10.21518/ms2024-406
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