Proefbehandeling met protonpompremmers ongeschikt als test voor gastro-oesofageale refluxziekte; een meta-analyse van de diagnostische-testeigenschappen

To determine the value of successful trial therapy with proton-pump inhibitors (PPIs) as a diagnostic test for gastro-oesophageal reflux disease (GERD).

Design

Systematic review and meta-analysis.

Method

Studies were included in which the clinical response to a short course (1-4 weeks) of PPI therapy could be related to abnormal results of 24-hr pH monitoring, gastroscopy, and/or diagnostic questionnaires. The sensitivity and specificity of the trial therapy were calculated. The ROC method was used to summarize the test characteristics across studies.

Results

With 24-hr pH monitoring as the reference standard, the positive likelihood ratio of the diagnosis ‘reflux disease’ ranged from 1.63 to 1.87 and the combined estimates of sensitivity and specificity in the various studies were 0.78 (95 CI: 0.66-0.86) and 0.54 (0.44-0.65), respectively. These values were lower with the other reference standards.

Conclusion

Although there were insufficient data to determine the effect of varying dosages of PPIs and duration of therapy on the test characteristics, successful short-term treatment with PPIs in patients suspected of having GERD provides insufficient certainty as to the diagnosis.