The impact of pre-endoscopy proton pump inhibitor use on the classification of non-erosive reflux disease and erosive oesophagitis
Article first published online: 28 SEP 2010
© 2010 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 32, Issue 10, pages 1266–1274, November 2010
How to Cite
Gaddam, S., Wani, S., Ahmed, H., Maddur, P., Hall, S. B., Gupta, N., Puli, S. R., Higbee, A., Rastogi, A., Bansal, A. and Sharma, P. (2010), The impact of pre-endoscopy proton pump inhibitor use on the classification of non-erosive reflux disease and erosive oesophagitis. Alimentary Pharmacology & Therapeutics, 32: 1266–1274. doi: 10.1111/j.1365-2036.2010.04468.x
- Issue published online: 19 OCT 2010
- Article first published online: 28 SEP 2010
- Publication data Submitted 28 June 2010 First decision 15 July 2010 Resubmitted 31 August 2010 Accepted 2 September 2010 EV Pub Online 28 September 2010
Vol. 34, Issue 11-12, 1356, Article first published online: 16 NOV 2011
Aliment Pharmacol Ther 2010; 32: 1266–1274
Background Factors associated with non-erosive reflux disease (NERD) and erosive oesophagitis (EO) are incompletely understood and the overlap between the two entities is debated.
Aim To compare clinical, demographic, and endoscopic findings in a large cohort of NERD and EO patients.
Methods After they completed a validated GERD questionnaire, patients who presented for index endoscopy were enrolled and categorized as NERD or EO. Analysis was performed using Chi-square, Mann–Whitney U-test and multivariate logistic regression.
Results A total of 696 GERD patients [455 (65.4%) NERD; 241 (34.6%) EO]; mean age 57 years; 92% men and 82% Caucasian were prospectively enrolled. Using logistic regression, patients on PPI were more likely to be classified as NERD (OR: 3.2; P < 0.001). NERD patients were older (OR: 1.50; P = 0.05), less likely to have nocturnal symptoms (OR: 0.63; P = 0.04) and hiatal hernia (OR: 0.32; P < 0.001). Compared with PPI-naïve NERD patients, those on PPI were more likely to have nocturnal symptoms (69% vs. 29%, P = 0.048) and less likely to have mild-moderate symptoms (63% vs. 79%, P < 0.001) – similar to the EO group.
Conclusions Pre-endoscopy PPI usage contributes significantly to the classification of GERD patients into the NERD-phenotype. NERD patients on PPI therapy demonstrate some features that are significantly different from PPI-naïve patients, but similar to EO patients. This observation supports the notion that some PPI NERD patients are actually healed EO patients, and that an overlap does exist between the GERD phenotypes.