Proton Pump Inhibitor Therapy Does Not Stop Gastroesophageal Reflux

Abstract

Purpose: Background PPI therapy is the standard treatment for gastro-esophageal reflux disease (GERD), and common wisdom is that proton pump inhibitor (PPI) therapy decreases reflux episodes. Multichannel intraluminal impedance-pH (MII-pH) testing allows for the identification of acid and non-acid reflux episodes, irrespective of the pH. Patients often remain on PPI therapy during MII-pH monitoring. Aim To determine if there is any difference in the number of reflux episodes in patients treated or not treated with PPI therapy. Methods: A retrospective review was performed of 300 patients (161 females; mean age 55 (range 19–82) years) undergoing MII-pH testing. The three hundred patients were divided into three groups of 100 patients each. One group took once-daily PPI (QD PPI), one group took twice-daily PPI (BID PPI), and the third group was not on PPI therapy (OFF PPI). Each study group was analyzed to determine the number of reflux episodes, as determined by MII-ph (Figure 1). A comparison of the three groups was done using ANOVAFigure 1: Reflux episode seen on a multichannel intraluminal impedance ph testResults:Table 1 shows the mean number of episodes per patient and its composition (acid versus nonacid) per study group. There was no statistical difference between the three groups using ANOVA.Table 1Conclusion: PPI therapy does not decrease gastroesophageal reflux. It merely changes the composition of the refluxate.