High-dose proton-pump inhibitors as a diagnostic test of gastrooesophageal reflux disease in endoscopic-negative patients

Background: To evaluate a high dose of a proton-pump inhibitor as a diagnostic test in endoscopy-negative patients presenting with symptoms indicating gastro-oesophageal reflux disease. Methods: 64 patients were studied in a prospective, randomized, double-blind study, using a cross-over design. After a run-in period with the diary registration of basic CORD symptoms and recording of the consumption of antacid tablets, the patients were given either 60 mg of lansoprazole once daily or placebo in randomized order. Symptoms were recorded, as well as antacid tablets taken in order to relieve pain. CORD was determined by 24-h oesophageal pH monitoring. The test was considered positive when consumption of antacid tablets was reduced greater than or equal to 75% compared to pretreatment. Results: In the GORD group, 29 (85%) tested positive during active treatment compared to 3 (9%) when on placebo. Corresponding figures for the non-GORD patients were 50% and 27%, giving a test sensitivity and specificity of 85% and 73%, respectively. During active treatment, VAS scores for acid regurgitation, heartburn and over all were significantly lowered in CORD patients, compared to heartburn only in the non-GORD group. Conclusions: 60 mg lansoprazole once daily for 5 days is an easy to use method fur diagnosing CORD in endoscopy-negative patients. Using 24-h oesophageal pH monitoring as the reference method, the sensitivity was relatively high, while the specificity was lower. Further studies are needed to determine how a PPI could be used as a diagnostic test in GORD.