Optimal Wireless Reflux Monitoring Metrics to Predict Discontinuation of Proton Pump Inhibitor Therapy

Area of Science:

• Gastroenterology
• Gastroesophageal Reflux Disease (GERD)
• Diagnostic Testing

Background:

• Ambulatory reflux monitoring off proton pump inhibitor (PPI) is the gold standard for diagnosing nonerosive GERD.
• Optimal diagnostic metrics and duration for this monitoring are not well-defined.
• Patients with suboptimal PPI response require refined diagnostic approaches.

Purpose of the Study:

• To evaluate diagnostic metrics and optimal duration of wireless reflux monitoring off PPI.
• To assess the performance of these metrics in predicting PPI discontinuation in patients with suboptimal PPI response.

Main Methods:

• A single-arm clinical trial enrolled adults with GERD symptoms and inadequate PPI response.
• Participants underwent 96-hour wireless pH monitoring off PPI.
• The primary outcome was successful PPI discontinuation within 3 weeks.

Main Results:

• 30% of 132 participants discontinued PPI.
• A total acid exposure time (AET) of 4.0% best predicted PPI discontinuation (OR 2.9).
• 96-hour monitoring outperformed 48-hour monitoring in predicting PPI discontinuation (AUC 0.63 vs 0.57).

Conclusions:

• A 4.0% AET threshold is a high-performing prognostic marker for PPI discontinuation.
• 96 hours of monitoring is superior to 48 hours for predicting PPI discontinuation.
• These findings can inform GERD diagnostic strategies for PPI-unresponsive patients.