Division of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, Via G.B. Grassi, Milano, Italy.
Dig Liver Dis. 2010 Nov;42(11):785-90. doi: 10.1016/j.dld.2010.04.002. Epub 2010 May 7.
There is no accepted gold standard for the diagnosis of gastroesophageal reflux disease (GERD).
To assess the optimal cut-off value and duration of the proton pump inhibitor (PPI) test in GERD patients with and without oesophagitis.
Prospective study of 544 patients undergoing upper GI endoscopy and treated for 2 weeks with PPIs at double dose, and for 3 additional months at standard dose. The status of the patient at end of treatment was used as an independent diagnostic standard, i.e. patients completely asymptomatic were considered as "true" GERD patients.
PPI test was positive in 89.7-97.8% of the patients according to the cut-off or duration of test used. Test sensitivity ranged from 95.5% to 98.8%, whereas specificity did not exceed 36.3%. Positive predictive values ranged from 87% to 80%, negative predictive values ranged from 58% to 70%, respectively.
The PPI test is a sensitive but poorly specific test in GERD patients. Its optimal duration is 1 week, and the optimal cut-off value is a decrease of heartburn score ≥75%. The diagnostic yield is higher in erosive oesophagitis compared with non-erosive reflux disease patients, similarly to the symptomatic response to 3-month PPI therapy.
目前尚无公认的胃食管反流病（GERD）诊断金标准。
评估质子泵抑制剂（PPI）试验在有和无食管炎的 GERD 患者中的最佳截断值和持续时间。
对 544 例接受上消化道内镜检查的患者进行前瞻性研究，这些患者接受双倍剂量的 PPI 治疗 2 周，然后标准剂量治疗 3 个月。治疗结束时患者的状况被用作独立的诊断标准，即完全无症状的患者被认为是“真正”的 GERD 患者。
根据所使用的截断值或试验持续时间，PPI 试验在 89.7-97.8%的患者中呈阳性。试验的灵敏度范围为 95.5%-98.8%，而特异性不超过 36.3%。阳性预测值范围为 87%-80%，阴性预测值范围为 58%-70%。
PPI 试验是一种敏感但特异性差的 GERD 患者检测方法。其最佳持续时间为 1 周，最佳截断值为烧心评分下降≥75%。与非糜烂性反流病患者相比，在有食管炎的患者中，PPI 试验的诊断效果更高，与 3 个月 PPI 治疗的症状缓解反应相似。
