P0316 - Comparison of Clinical Characteristics Between Refractory Heartburn versus Refractory Gastroesophageal Reflux Disease Patients

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

FS

Fahmi Shibli, MD

Esophageal and Swallowing Center, MetroHealth Medical Center, Case Western Reserve University
Nof HaGalil, HaZafon, Israel

Fahmi Shibli, MD¹, Yeseong Kim, MD², Ali El Mokahal, MD², Ronnie Fass, MD¹
¹Esophageal and Swallowing Center, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH; ²MetroHealth Medical Center, Cleveland, OH

Introduction: Refractory gastroesophageal reflux disease (rGERD) indicates treatment failure in patients with objective documentation of GERD whereas refractory heartburn (rHB) indicates treatment failure in patients with heartburn but without objective evidence of GERD. Treatment failure is considered as partial or lack of symptomatic response to twice daily PPI given over a period of 12 weeks. It has been suggested that rGERD and rHB represent two different patient populations, but there has not been an attempt in the literature to separate these two groups. Therefore, the aim of our study was to compare the clinical characteristics between rGERD versus rHB patients.

Methods: Patients with heartburn who have failed twice daily PPI after a 12-week period were included in this study. Patients were separated to rGERD and rHB based on the presence or absence of positive test results including endoscopy, esophageal manometry, impedance-pH and pH monitoring while off PPI treatment. Demographics, tobacco use, alcohol use, BMI, co-morbidities, medications, medical and surgical treatment, as well as surgical history were also documented. Bivariate analysis was performed between the rGERD and rHB cohorts in the formats of Student’s t-test and Chi-squared test for continuous and categorical variables, respectively. Bonferroni correction was applied to account for multiple comparisons, statistical significance was set at p-value 0.048.

Results: A total of 109 and 70 patients with rGERD and rHB, respectively, were included in this study. Comparison of clinical characteristics revealed significant differences in hypertension (32.9% rHB vs 10.1% rGERD, p-value 0.0005), diabetes mellitus (38.6% rHB vs 16.5% rGERD, p-value 0.0017), and heart disease (17.1% rHB vs 3.7% rGERD, p-value 0.0070). There was no difference in demographics, other comorbidities, such as sleep apnea, autoimmune disorders, liver, and thyroid diseases, anti-reflux medical or surgical therapy between the 2 groups.

Discussion: Patients with rHB demonstrate a significantly higher prevalence of important comorbidities as compared with the rGERD group. There was no difference between rHB and rGERD in regard to medical or surgical treatment despite the fact that rHB patients commonly have functional esophageal disorders that drive their heartburn.

Measure	Refractory Heartburn n=109 (61%)	Refractory GERD n=70 (39%)	P value
Surgery history	15(13.8)	12(17.1)	0.7012
Medications PPI H2RA Carafate BB CCB Nitroglycerin Antispasmodics Anticholinergics TCA SSRI SNRI Opioid Benzodiazepines Prokinetics Baclofen Sildenafil/ Tadalafil	109(100) 20(18.3) 10(9.2) 27(24.8) 14(12.8) 7(6.4) 4(3.7) 0(0) 7(6.4) 19(17.4) 6(5.5) 9(8.3) 11(10.1) 4(3.7) 2(1.8) 3(2.8)	70(100) 20(28.6) 11(15.7) 13(18.6) 12(17.1) 2(2.9) 4(5.7) 0(0) 6(8.6) 20(28.6) 7(10) 6(8.6) 5(7.1) 3(4.3) 3(4.3) 0(0)	----- 0.1073 0.1887 0.3328 0.4263 0.2972 0.5291 ----- 0.5810 0.0773 0.2589 0.9439 0.4933 0.8408 0.3219 0.1591
PPI, proton pump inhibitor; H2RA, histamine 2 receptor antagonist; BB, beta blocker; CCB, calcium channel blocker; TCA, tricyclic anti-depressant; SSRI, selective serotonin reuptake inhibitor; SNRI, serotonin norepinephrine reuptake inhibitor.

Table: Comparison of Medical and Surgical Treatment between Refractory Heartburn and Refractory GERD.

Disclosures:

Fahmi Shibli indicated no relevant financial relationships.

Yeseong Kim indicated no relevant financial relationships.

Ali El Mokahal indicated no relevant financial relationships.

Ronnie Fass indicated no relevant financial relationships.

Fahmi Shibli, MD¹, Yeseong Kim, MD², Ali El Mokahal, MD², Ronnie Fass, MD¹. P0316 - Comparison of Clinical Characteristics Between Refractory Heartburn versus Refractory Gastroesophageal Reflux Disease Patients, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.