pH-Impedance Findings and proton pump inhibitors-responsiveness in patients with typical gastroesophageal reflux disease symptoms in a large single-center Italian series.

Introduction: A multicenter study with a limited sample size found that absence of esophagitis, presence of functional digestive disorders, and overweight were associated with proton pump inhibitors (PPI) failure. Aim: To assess clinical and reflux patterns associated with PPI-responsiveness. Materials and Methods: Patients with typical gastroesophageal reflux disease (GORD) symptoms had 24 hours pH-impedance monitoring off therapy. Responders had < 2 days of symptoms per week while on standard-dose/double-dose PPI. Clinical and reflux parameters were considered for analysis. Results: A total of 514 patients were included (267 women), 185 patients were considered PPI responders, and 329 were considered nonresponders. In the whole population, the only significant factor in the prediction of responsiveness to PPI at the multivariate analysis was the presence of esophagitis (P = 0.028). The factors identified as significant in patients with a pathologic acid exposure (142 patients) in the prediction of responsiveness to PPI were overweight (body mass index > 25kg/m(2)) and the presence of esophagitis (P = 0.019 and 0.043, respectively). Conclusions: We confirm that no reflux pattern demonstrated by 24 hours pH-impedance monitoring is associated to PPI response in GORD patients. Presence of esophagitis in the whole population and overweight in patients with pathologic GORD, but not dyspepsia, are strongly associated with PPI-responsiveness.