P1345 - Diagnostic Accuracy of the Proton Pump Inhibitor Test in Patients With Erosive and Non-Erosive Reflux Disease: A Systematic Review and Meta-Analysis

Sara Ghoneim, MD¹, Nabil El Hage Chehade, MD², Jiasheng Wang, MD², Stephen Ganocy, PhD³, Ehsan Chitsaz, MD², Ronnie Fass, MD^4
1University of Nebraska Medical Center, Omaha, NE; ²MetroHealth Medical Center, Cleveland, OH; ³University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH; ⁴Esophageal and Swallowing Center, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH

Introduction: In clinical setting, the PPI test remains a reasonable diagnostic tool for patients with suspected gastroesophageal reflux disease (GERD). Erosive reflux disease (ERD) and non-erosive reflux disease (NERD) are two distinct phenotypes of GERD. More information is needed about the utility of the PPI test in these two groups. We conducted a systematic review and meta-analysis to examine the diagnostic performance of the PPI test in patients with ERD and NERD.

Methods: Web of Science, Cochrane Controlled Register of Trials [CENTRAL] and PubMed/MEDLINE were searched for studies reporting the diagnostic accuracy of the PPI test in adult patients with GERD who underwent evaluation using upper endoscopy and esophageal pH-monitoring from January 1^st, 1950 through February 1^st, 2021. Subgroup analyses were performed based on study design and GERD phenotype. Summary estimates of sensitivity, specificity and diagnostic odds for the PPI test were determined using bivariate random effects model. Heterogeneity was assessed by the Paule-Mandel tau square (τ²), I² index, and Cochran’s Q test.

Results: A total of 5 studies involving 127 ERD patients and 172 NERD patients were included in the final analysis. In ERD, the PPI test had 76% pooled sensitivity (95% CI, 66%-84%; I²= 0%, P= 0.28) and 30% pooled specificity (95% CI, 8%-67%; I²= 66%, P= 0.76). In NERD, the PPI test had 79% pooled sensitivity (95% CI, 70%-86%; I²= 0%, P= 0.28) and 50% pooled specificity (95% CI, 39%-61%;I²= 0%, P= 0.54).The overall diagnostic odds ratio (DOR) was 1.41 (95% CI, 0.30-0.68;I²= 57%, P= 0.10) in ERD and 3.83 (95% CI, 1.92-7.61; I²= 0%, P= 0.87) in NERD.

Discussion: The PPI test performed slightly better in NERD but with overall comparable diagnostic utility in both phenotypes. Future studies with larger cohorts stratified by GERD phenotype are needed to further investigate our findings.


Figure: Figure 1. Forest Plots of Pooled Estimates of (A) Sensitivity and (B) Specificity of The PPI test in ERD and NERD.

Table: Table 1. Characteristics of study included in analysis. Abbreviations: No., number; PPI, proton pump inhibitor; M, male; F, female; NA, not available; pH-metry, esophageal pH-monitoring; BID, twice daily.


Disclosures:
Sara Ghoneim indicated no relevant financial relationships.
Nabil El Hage Chehade indicated no relevant financial relationships.
Jiasheng Wang indicated no relevant financial relationships.
Stephen Ganocy indicated no relevant financial relationships.
Ehsan Chitsaz indicated no relevant financial relationships.
Ronnie Fass indicated no relevant financial relationships.


Sara Ghoneim, MD¹, Nabil El Hage Chehade, MD², Jiasheng Wang, MD², Stephen Ganocy, PhD³, Ehsan Chitsaz, MD², Ronnie Fass, MD⁴. P1345 - Diagnostic Accuracy of the Proton Pump Inhibitor Test in Patients With Erosive and Non-Erosive Reflux Disease: A Systematic Review and Meta-Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.