POEMs

PPI Helpful for HP-Negative Dyspepsia with Normal Endoscopy, Especially if Overweight



FREE PREVIEW Log in or buy this issue to read the full article. AAFP members and paid subscribers get free access to all articles. Subscribe now.


FREE PREVIEW Subscribe or buy this issue. AAFP members and paid subscribers get free access to all articles.

Am Fam Physician. 2012 Nov 1;86(9):online.

Clinical Question: Which patients with normal upper endoscopy and negative Helicobacter pylori study results are likely to benefit from a proton pump inhibitor?

Bottom Line: Among dyspeptic patients who are negative for Helicobacter pylori (HP) and have a normal endoscopy, approximately half of those who are overweight or obese and one fifth of those who are normal weight will respond to a proton pump inhibitor (PPI). (Level of Evidence: 1b)

Reference: Fletcher J, Derakhshan MH, Jones GR, Wirz AA, McColl KE. BMI is superior to symptoms in predicting response to proton pump inhibitor: randomised trial in patients with upper gastrointestinal symptoms and normal endoscopy. Gut 2011;60(4):442-448.

Study Design: Randomized controlled trial (nonblinded)

Funding Source: Industry

Allocation: Concealed

Setting: Outpatient (specialty)

Synopsis: You've referred your patient with dyspepsia for endoscopy and the result is normal. Her HP results were normal, as well. Will a PPI help? This study identified 105 similar patients and randomized them in a 2:1 ratio to receive lansoprazole 30 mg per day or placebo. The primary outcome was the Glasgow Dyspepsia Severity Score, measured 2 weeks later. Patients and outcome assessors were masked, allocation was concealed, and analysis was by intention to treat. Most patients had a chief complaint of retrosternal pain or regurgitation (43%), epigastric pain (42%), or nausea and vomiting (9%). Not terribly surprisingly, patients receiving the PPI were more likely to experience a clinically meaningful 50% reduction in their symptom score (36% vs 6%; P < .001; number needed to treat [NNT] = 3). More interesting, the only noninvasive predictor of response to PPI was increasing body mass index (BMI). Patients with a BMI of at least 25 kg/m2 had a 53% response rate, compared with only 23% of those with a BMI below that cutoff (NNT = 3). In general, symptoms were found to be of little value in predicting response to a PPI in this group of patients.

POEMs are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com.

 

Want to use this article elsewhere? Get Permissions


Article Tools

  • Print page
  • Share this page
  • AFP CME Quiz

Information From Industry

Navigate this Article