Relationship between symptom response and the esophageal pH level on standard dose of esomeprazole treatment for gastro-esophageal reflux disease

Relationship between symptom response and the esophageal pH level on standard dose of esomeprazole treatment for gastro-esophageal reflux disease

Objective To evaluate the relationship between symptom response and gastro-esophageal acidity control in Chinese gastro-esophageal reflux disease (GERD) patients on esomeprazole therapy, and to assess the role of 24-hr esophageal pH-metry after therapy in GERD patients. Methods GERD patients with typical reflux symptoms were enrolled and received esomeprazole 40 mg once daily for 4 weeks. Patients with positive baseline 24-hr esophageal pH-metry were divided into two groups depending on an additional dual-channel 24-hr pH-metry after treatment; the pH- group achieved normalization of esophageal pH level whereas the pH+ group did not. Results Of the 80 patients studied, 76 had abnormal baseline esophageal pH levels. Of these, 89.7% (52/58) of symptom-free patients and 66.7% (12/18) of symptom-persistent patients achieved esophageal pH normalization after therapy (P=0.030). The mean post-therapy gastric nocturnal % time of pH< 4 was significantly higher in pH+ group than that in pH- group (P<0.001) after therapy. The multivariate regression analysis identified hiatus hernia (P<0.001) and persistent reflux symptom (P=0.004) were 2 independent factors predicting the low post-therapy esophageal pH level. Conclusion Symptom elimination is not always accompanied by esophageal pH normalization, and vice verse. Esophageal pH-metry is recommended for GERD patients with hiatus hernia or with persistent reflux symptoms after PPI therapy.