Long-Term Reflux Outcomes-A Pragmatic Study of Mucosal Integrity Testing

Area of Science:

• Gastroenterology
• Diagnostic Medicine
• Medical Technology

Background:

• Gastroesophageal reflux disease (GERD) diagnosis often relies on symptom reporting and empirical treatment.
• Proton pump inhibitors (PPIs) are a cornerstone of GERD management, but long-term use has potential side effects.
• Mucosal integrity testing (MI) offers a potential objective measure for GERD assessment.

Purpose of the Study:

• To evaluate if mucosal integrity testing (MI) can predict long-term improvement in GERD symptoms.
• To determine if MI can predict the ability of patients to discontinue proton pump inhibitors (PPIs).

Main Methods:

• A cohort of patients with suspected GERD underwent MI, with or without wireless pH capsule placement.
• GERD-Questionnaire (GERD-Q) and GERD-Health-Related Quality of Life (GERD-HRQL) scores were collected at follow-up.
• Logistic regression models analyzed the probability of reflux resolution and PPI discontinuation.

Main Results:

• Complete resolution of reflux symptoms occurred in 73% of patients at a median 2.5-year follow-up.
• 33% of patients with complete resolution no longer required PPIs, compared to 13% with partial resolution.
• MI was a better predictor (C-index 0.71) of long-term reflux resolution than pH monitoring (C-index 0.49).

Conclusions:

• This study demonstrates that changes in mucosal integrity can predict long-term GERD outcomes.
• Higher mucosal impedance, indicating normal mucosal integrity, is associated with successful long-term PPI discontinuation.
• MI shows promise as a predictive tool for guiding GERD management and treatment de-escalation.