Evaluating the clinical efficacy of therapies in patients with symptoms of gastroesophageal reflux disease after phenotyping based on 24-h pH-impedance monitoring

Introduction. The inefficiency of proton pump inhibitors (PPIs) in patients with symptoms of gastroesophageal reflux disease (GERD) may be caused by functional esophageal diseases, which should be diagnosed by using pH-impedance monitoring. Aim. To evaluate the clinical efficacy of therapies in patients with symptoms of gastroesophageal reflux disease after phenotyping based on 24-h pH-impedance monitoring. Materials and methods. A total of 61 patients with GERD symptoms were observed in a prospective study. The patients were categorized into 3 phenotypes based on the Lyon Consensus 2.0 and Rome criteria IV: nonerosive reflux disease (NERD), hypersensitive esophagus (HSE), functional heartburn (FH). The 5-point Likert scale was used to measure the severity of symptoms. NERD patients received PPI (omeprazole 20 mg twice daily), HSE patients received PPI (omeprazole 20 mg twice daily) and a selective serotonin reuptake inhibitor (SSRI) (citalopram 20 mg daily), FH patients received tricyclic antidepressant (TCA) (amitriptyline ¼ tablet at the bedtime). The entire length of treatment in all groups was 4 weeks. Results. The severity of heartburn in patients with NERD, HSE and FH before treatment averaged 3.23 (95% CI 3.02–3.43) points on the Likert scale (strong). Due to therapy, the average score in the NERD group decreased from 3.48 (95% CI 3.23–3.74) to 0.77 (95% CI 0.53–1.01), in the HSE group from 2.92 (95% CI 2.41–3.42) to 0.83 (95% CI 0.30–1.36), and in the FH group from 2.86 (95% CI 2.41–3.30) to 0.86 (95% CI 0.41–1.30). The efficacy of therapy in NERD patients was 85%. The efficacy of PPI + SSRI and TCA in patients with HSE and FH was 83% and 79%, respectively. Conclusion. A differentiated approach to the treatment of patients with heartburn symptoms based on phenotyping using 24-h impedance-pH findings can help optimize the therapy and improve its efficiency.