OMEPRAZOLE AS A DIAGNOSTIC-TOOL IN GASTROESOPHAGEAL REFLUX DISEASE

Objective: To determine the diagnostic value of empirical treatment wi th omeprazole in the diagnosis of gastroesophageal reflux disease (GER D), Methods: Patients with symptoms suggestive of GERD underwent upper gastrointestinal endoscopy and 24-h esophageal pH monitoring, Patient s with reflux esophagitis grade 0 or 1 were included in the study and were randomized to double-blind treatment with either 40 mg omeprazole or placebo o.m. The effect of treatment was evaluated after 1 and 2 w k with a symptom questionnaire with a four-grade Likert scale, and sym ptomatic response outcome was compared with the results of 24-h pH-met ry, Results: Ninety-eight patients were included; however, 13 were exc luded from the final analysis because of protocol violation, Of the re maining 85 patients, 54 had no signs of esophagitis at endoscopy, and 31 had esophagitis grade 1, The pH registration showed pathological ga stroesophageal reflux in 47 patients (55%), Forty-one patients were ra ndomized to treatment with omeprazole and 44 to placebo, There was a s ignificant correlation between the pH registration result and response to omeprazole (p = 0.04, chi(2)), but not to placebo (p = 0.16), With ps-metry as the gold standard, the omeprazole test had positive and n egative predictive values of 68% and 63%, respectively, for the diagno sis of GERD, When the omeprazole test was used as the gold standard, t he positive and negative predictive values of pH monitoring were 68% a nd 63%, respectively, Similar sensitivity was found when the pH-metry was compared with presence of esophagitis, Conclusion: Determination o f the symptomatic response to 40 mg of omeprazole for 14 days is a sim ple and inexpensive tool for the diagnosis of GERD, with a sensitivity and specificity comparable to 24-h pH monitoring.