Predictors of treatment response in patients with non-erosive reflux disease


Dr N. J. Talley, Professor of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, PL-6-56, Rochester, MN 55905, USA.




Up to 40% of patients with non-erosive reflux disease (NERD) fail to respond to proton pump inhibitor therapy.


To determine useful prognostic factors for response to and suppression in NERD.


A pooled analysis from three multicentre, double-blind trials of patients with a normal endoscopy and heartburn for 4 days or more during the 7 days prior to the start of each treatment. Patients received omeprazole 20 mg, esomeprazole 20 mg or esomeprazole 40 mg/day for 4 weeks. Complete resolution of heartburn was defined as no heartburn during the last week.


Of 2458 patients included, complete heartburn resolution was achieved in 63% at the end of 4 weeks treatment. Response on days 5–7 provided an 85% probability of complete resolution of heartburn at 4 weeks; the probability of complete heartburn resolution at 4 weeks in those with moderate to severe symptoms on days 5–7 was 22%. Sensitivity and specificity of no heartburn on days 5–7 was 55% and 83% respectively. Patient demographics, duration of symptoms, medications used, other symptoms and body mass index were not predictors.


Assessment of heartburn resolution during the first week of therapy was the best predictor of treatment success at 4 weeks in non-erosive reflux disease, but was suboptimal as a test.