972 Yield of Diagnostic Tests for Celiac Disease in Dyspepsia: Systematic Review and Meta-Analysis

Abstract

comitant reflux symptoms more than twice a month and NSAID or PPI use in recent 4 weeks. Patients with normal endoscopy and tested negative for Helicobacter pylori were then invited to undergo 24-hour esophageal pH study. Abnormal esophageal pH study was defined as acid exposure time >4% or symptom association probability >95%. All patients were then given open-labelled esomeprazole 20 mg daily for 8 weeks. Dyspeptic symptoms and global symptom assessment were evaluated at the end of treatment. Treatment response was defined as satisfactory relief of dyspepsia using global symptom assessment. RESULTS: 135 patients (Male: 40%; mean age:42±12) were studied. 38 (28.1%) patients had abnormal pH study (pH +ve). There was no significant difference in demographics, concomitant monthly reflux symptom (pH +ve Vs pH -ve: 15.8% Vs 11.3%, p=0.57), irritable bowel syndrome (pH +ve Vs pH -ve: 42.1% Vs 38.1%, p=0.67) and subtypes of FD (pH +ve Vs pH -ve)(ulcer-like: 29% vs 23%, dysmotility-like: 26% Vs 32%, non-specific: 45% Vs 45%, p=0.70). Treatment response was observed in 23 (60.5%) pH positive patients and 35 (36.1%) pH negative patients, respectively (p=0.01). pH +ve patients had significantly lower symptom scores for epigastric burning (median score: 1 Vs 2, p=0.01) and postprandial fullness (median score: 1 Vs 2, p=0.03) compared to pH negative patients after esomeprazole treatment. There was no difference in treatment response rate among the various subtypes of FD in both groups of patients. In multivariate analysis, abnormal pH study was the only independent predictor of treatment response (RR: 2.4, 95%CI: 1.8-3.9). CONCLUSION: Among FD patients without concomitant GERD, abnormal esophageal pH study is present in a subset of patients with high treatment response rate to PPI. Our findings support the notion that PPI is mainly effective for relief of dyspeptic symptoms related to acid reflux.