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World J Gastroenterol. Apr 28, 2006; 12(16): 2569-2573
Published online Apr 28, 2006. doi: 10.3748/wjg.v12.i16.2569
Rabeprazole test for the diagnosis of gastro-oesophageal reflux disease: Results of a study in a primary care setting
Stanislas Bruley des Varannes, Sylvie Sacher-Huvelin, Fabienne Vavasseur, Claude Masliah, Marc Le Rhun, Philippe Aygalenq, Sylvie Bonnot-Marlier, Yves Lequeux, Jean Paul Galmiche
Stanislas Bruley des Varannes, Sylvie Sacher-Huvelin, Fabienne Vavasseur, Claude Masliah, Marc Le Rhun, Jean Paul Galmiche, Institut des Maladies de l’Appareil Digestif, CIC-INSERM-CHU - 44083 NANTES cedex, France
Yves Lequeux, 4, rue de la Tourelle - 44230 SAINT PERE en RETZ, France
Philippe Aygalenq, CH Draguignan, France
Sylvie Bonnot-Marlier, Laboratoire JANSSEN-CILAG - 1, Avenue Camille Desmoulins - 92787 ISSY les MOULINEAUX cedex, France
Author contributions: All authors contributed equally to the work.
Correspondence to: Pr Jean Paul Galmiche, MD, FRCP, Institut des Maladies de l’Appareil Digestif, CIC-INSERM-CHU - 44083 NANTES cedex, France. jeanpaul.galmiche@chu-nantes.fr
Telephone: +33-2-40083028
Received: September 29, 2005
Revised: October 16, 2005
Accepted: October 26, 2005
Published online: April 28, 2006
Abstract

AIM: To determine the diagnostic value of the rabeprazole test in patients seen by general practitioners.

METHODS: Eighty-three patients with symptoms suggestive of GERD were enrolled by general practitioners in this multi-centre, randomized and double-blind study. All patients received either rabeprazole (20 mg bid) or a placebo for one week. The diagnosis of GERD was established on the presence of mucosal breaks at endoscopy and/or an abnormal esophageal 24-h pH test. The test was considered to be positive if patients reported at least a “clear improvement” of symptoms on a 7-point Likert scale.

RESULTS: The sensitivities of the test for rabeprazole and the placebo were 83% and 40%, respectively. The corresponding specificity, positive and negative predictive values were 45% and 67%, 71% and 71%, and 62% and 35%, respectively. A receiver operating characteristics (ROC) analysis confirmed that the best discriminatory cut-off corresponded to description of “clear improvement”.

CONCLUSION: The poor specificity of the proton-pump inhibitor (PPI) test does not support such an approach to establish a diagnosis of GERD in a primary care setting.

Keywords: Gastro-oesophageal reflux disease; Diagnostic tool; Rabeprazole; Proton pump inhibitors; Primary care