%0 Journal Article
%T Diagnostic yield of ambulatory oesophageal studies on versus off proton pump inhibitors: a systematic review and meta
%A Daphne Ang
%A Jan Tack
%A Luming Shi
%A Qishi Zheng
%J United European Gastroenterology Journal
%@ 2050-6414
%D 2018
%R 10.1177/2050640618772787
%X Patients with persistent gastroesophageal reflux disease symptoms despite proton pump inhibitors are increasingly encountered. It remains controversial if proton pump inhibitors should be stopped before functional oesophageal tests. This meta-analysis compares the positive yield of oesophageal studies performed off versus on proton pump inhibitors. Pubmed, Embase and the Cochrane Library were searched for eligible studies. Outcomes assessed were the number of subjects with: elevated oesophageal acid exposure time when studied off versus on proton pump inhibitors; positive symptom index (≡50%) and/or positive symptom association probability (≡95%) for acid reflux; and/or non-acid reflux events off versus on proton pump inhibitors. The random effects model was applied. Fifteen studies (nˋ=ˋ5033 individuals; 33% on proton pump inhibitors; 32% men; mean age 52.1 years) were analysed. Pooled risk ratio for the comparison of high oesophageal acid exposure time off versus on proton pump inhibitors was 2.16 (95% confidence interval (CI) 1.42每3.28). The risk ratio of a positive symptom index (acid reflux) was 2.64 (95% CI 1.52每4.57) and the risk ratio of a positive symptom association probability (acid reflux) was 2.94 (95% CI 2.31每3.74). Conversely, the risk ratio of a positive symptom index (non-acid reflux) was 0.96 (95% CI 0.49每1.88) and risk ratio of a positive symptom association probability (non-acid reflux) was 0.54 (95% CI 0.30每0.99). Oesophageal studies after proton pump inhibitor cessation improve the positive yield for acid reflux-related events but reduce the detection of symptomatic non-acid reflux events
%K Reflux evaluation
%K gastroesophageal reflux disease
%K acid reflux
%K non-acid reflux
%U https://journals.sagepub.com/doi/full/10.1177/2050640618772787