Rabeprazole test for the diagnosis of gastro-oesophageal reflux disease: results of a study in a primary care setting.

Author(s): des Varannes SB, Sacher-Huvelin S, Vavasseur F, Masliah C, Le Rhun M, Aygalenq P, Bonnot-Marlier S, Lequeux Y, Galmiche JP

Affiliation(s): Institut des Maladies de l'Appareil Digestif, CIC-INSERM-CHU - NANTES, France.

Publication date & source: 2006-04-28, World J Gastroenterol., 12(16):2569-73.

Publication type: Multicenter Study; Randomized Controlled Trial

AIM: To determine the diagnostic value of the rabeprazole test in patients seen by general practitioners. METHODS: Eighty-three patients with symptoms suggestive of GERD were enrolled by general practitioners in this multi-centre, randomized and double-blind study. All patients received either rabeprazole (20 mg bid) or a placebo for one week. The diagnosis of GERD was established on the presence of mucosal breaks at endoscopy and/or an abnormal esophageal 24-h pH test. The test was considered to be positive if patients reported at least a "clear improvement" of symptoms on a 7-point Likert scale. RESULTS: The sensitivities of the test for rabeprazole and the placebo were 83% and 40%, respectively. The corresponding specificity, positive and negative predictive values were 45% and 67%, 71% and 71%, and 62% and 35%, respectively. A receiver operating characteristics (ROC) analysis confirmed that the best discriminatory cut-off corresponded to description of "clear improvement". CONCLUSION: The poor specificity of the proton-pump inhibitor (PPI) test does not support such an approach to establish a diagnosis of GERD in a primary care setting.