More than half of patients taking PPIs still experience heartburn, regurgitation

USA: More than half of the patients taking daily proton pump inhibitor (PPI) therapy for gastroesophageal reflux disorder (GERD) symptoms still experience persistent GERD symptoms including heartburn, regurgitation, finds a recent study published in the journal Gastroenterology.

According to the study, heartburn, regurgitation was reported by 54.1 percent of GERD participants taking PPIs daily.

GERD is a digestive disorder that affects the lower esophageal sphincter (LES), the muscle ring between the stomach and the esophagus. It occurs when bile or stomach acid flows into the food pipe and irritates the food pipe-lining. PPIs are a type of medication that can be used for the reduction of stomach acid and relieve the symptoms of GERD.

Sean D. Delshad, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, and colleagues performed a population-based study to determine the prevalence of GERD symptoms and persistent GERD symptoms despite use of PPIs.

For the purpose, the researchers conducted the National Gastrointestinal Survey in 2015 using MyGiHealth -- an app that guides participants through National Institutes of Health gastrointestinal PROMIS surveys

Primary outcomes were prevalence of GERD symptoms in the past and persistence of GERD symptoms (heartburn or regurgitation 2 or more days in the past week) among participants taking PPIs. Population weights were applied to the data and multivariable regression was used to adjust for confounding.

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Key findings of the study include:

• Among 71,812 participants, 32,878 (44.1%) reported having had GERD symptoms in the past and 23,039 (30.9%) reported having GERD symptoms in the last week.


• 35.1% of those who had experienced GERD symptoms were currently on therapy (55.2% on PPIs, 24.3% on histamine-2 receptor blockers, and 24.4% on antacids).


• Among 3,229 participants taking daily PPIs, 54.1% had persistent GERD symptoms.


• Younger individuals, women, Latinos, and participants with irritable bowel syndrome or Crohn's disease were more likely to have continued symptoms, even when taking PPIs.

"GERD symptoms were found to be common: 2 of 5 participants have had GERD symptoms in the past and 1 of 3 had symptoms in the last week. We also found that half of PPI users have persistent symptoms. Given the significant effect of GERD on quality of life, further research and development of new therapies are needed for patients with PPI-refractory GERD symptoms," concluded the authors.

The study, "Prevalence of Gastroesophageal Reflux Disease and Proton Pump Inhibitor-Refractory Symptoms," is published in the journal Gastroenterology.

DOI: https://doi.org/10.1053/j.gastro.2019.12.014