Improved diagnosis of reflux hypersensitivity

Area of Science:

• Gastroenterology
• Digestive Health
• Esophageal Disorders

Background:

• Reflux hypersensitivity (RH) involves normal acid exposure but symptom correlation with reflux.
• Current diagnosis uses Symptomatic Index (SI) and/or Symptom Association Probability (SAP), though expert opinion favors concordance of both.
• This study investigates differences in RH patients based on SI/SAP concordance.

Purpose of the Study:

• To evaluate differences between patients with reflux hypersensitivity (RH) and those without, focusing on the concordance of Symptomatic Index (SI) and Symptom Association Probability (SAP).
• To assess the diagnostic utility of different criteria for RH, including definite (both SI and SAP positive) versus indefinite (only one positive).
• To compare PPI responsiveness and impedance parameters between RH subtypes and functional heartburn (FH).

Main Methods:

• Included 2659 patients with typical reflux symptoms, undergoing simultaneous pH-impedance and high-resolution manometry off PPI.
• Assessed patient response to proton pump inhibitors (PPI).
• Classified RH as definite (SI and SAP positive) or indefinite (SI or SAP positive).

Main Results:

• RH was diagnosed in 29.3% of patients (definite: 14.3%, indefinite: 15%).
• Definite RH patients exhibited increased reflux time, reflux episodes, and hiatus hernia length compared to indefinite RH.
• Definite RH patients showed a significantly higher PPI response rate than functional heartburn (FH) patients.

Conclusions:

• Proton pump inhibitor (PPI) responsiveness is common in both RH and FH, limiting its clinical discriminatory power for RH diagnosis based on SI and/or SAP positivity alone.
• Patients with RH and SI/SAP concordance differ significantly from those without concordance.
• Adopting a strict RH definition requiring both SI and SAP positivity is recommended for better differentiation from FH.