Brief Article
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World J Gastroenterol. Mar 7, 2011; 17(9): 1160-1166
Published online Mar 7, 2011. doi: 10.3748/wjg.v17.i9.1160
Gastroesophageal reflux disease management according to contemporary international guidelines: A translational study
Fabio Pace, Gabriele Riegler, Annalisa de Leone, Patrizia Dominici, Enzo Grossi, the EMERGE Study Group
Fabio Pace, Annalisa de Leone, Division of Gastroenterology, Department of Clinical Sciences, “L. Sacco” University Hospital, 74-20157 Milano, Italy
Gabriele Riegler, “Magrassi-Lanzara” Department of Clinical and Experimental Medicine, 2nd University of Naples, 80100 Naples, Italy
Patrizia Dominici, Enzo Grossi, Medical Department, Bracco Imaging SpA, 24100 Milano, Italy
Author contributions: Pace F and Grossi E contributed to study concept and design; EMERGE study group collected the data; de Leone A, Dominici P and Riegler G contributed to analysis and interpretation of the data; de Leone A and Pace F wrote the manuscript; all authors read and approved the paper.
Correspondence to: Dr. Fabio Pace, MD, Department of Clinical Sciences, “L. Sacco” University Hospital, Via G. B. Grassi, 74-20157 Milano, Italy. fabio.pace@unimi.it
Telephone: +39-35-3063658 Fax: +39-35-3063457
Received: March 29, 2010
Revised: June 21, 2010
Accepted: June 28, 2010
Published online: March 7, 2011
Abstract

AIM: To test the Genval recommendations and the usefulness of a short trial of proton pump inhibitor (PPI) in the initial management and maintenance treatment of gastroesophageal reflux disease (GERD) patients.

METHODS: Five hundred and seventy seven patients with heartburn were recruited. After completing a psychometric tool to assess quality of life (PGWBI) and a previously validated GERD symptom questionnaire (QUID), patients were grouped into those with esophagitis (EE, n = 306) or without mucosal damage (NERD, n = 271) according to endoscopy results. The study started with a 2-wk period of high dose omeprazole (omeprazole test); patients responding to this PPI test entered an acute phase (3 mo) of treatment with any PPI at the standard dose. Finally, those patients with a favorable response to the standard PPI dose were maintained on a half PPI dose for a further 3-mo period.

RESULTS: The test was positive in 519 (89.9%) patients, with a greater response in EE patients (96.4%) compared with NERD patients (82.6%) (P = 0.011). Both the percentage of completely asymptomatic patients, at 3 and 6 mo, and the reduction in heartburn intensity were significantly higher in the EE compared with NERD patients (P < 0.01). Finally, the mean PGWBI score was significantly decreased before and increased after therapy in both subgroups when compared with the mean value in a reference Italian population.

CONCLUSION: Our study confirms the validity of the Genval guidelines in the management of GERD patients. In addition, we observed that the overall response to PPI therapy is lower in NERD compared to EE patients.

Keywords: Gastroesophageal reflux disease; Proton pump inhibitors; Nonerosive gastroesophageal reflux; Questionnaire; Quality of life