Evaluation of omeprazole as a cost-effective diagnostic test for gastro-oesophageal reflux disease

Background: There is a need for a simple, therapeutic test that is of diagn ostic value and can also provide rapid symptom relief in patients who prese nt with classic, mild symptoms suggestive of gastro-oesophageal reflux dise ase (GERD), when the diagnosis is based on symptom assessment alone. Aim: To assess the diagnostic value of a therapeutic trial of omeprazole 40 mg in a dyspeptic population. Methods: A total of 90 patients with symptoms suggestive of GERD entered th e study, Patients underwent endoscopy and ambulatory oesophageal pH monitor ing for 18-24 h. Patients then received omeprazole 40 mg o.m. for 2 weeks. Results: There was a significant correlation between the diagnoses obtained from a trial of omeprazole and the diagnoses obtained from pH monitoring ( P < 0.05). There was no significant correlation between the diagnoses obtai ned from endoscopy and those obtained from pH monitoring. Both omeprazole a nd endoscopy were compared to pH monitoring as the 'gold standard' for the diagnosis of GERD and the cost per correct diagnosis with omeprazole was po und 47 (95% CI: pound 40-pound 59) compared to pound 480 (95% CI: pound 396 -pound 608) with endoscopy. There was a complete absence of acid-related sy mptoms in the majority (59%) of patients after 3 days of omeprazole 40 mg t herapy and, after 2 weeks, 82% of patients had experienced an improvement i n overall symptoms (greater than or equal to 1 grade). Conclusions: We conclude that umeprazole can be used as a clinically effect ive tool in the initial management of GERD and that it is of diagnostic val ue in patients who present with typical symptoms, such as heartburn, when t he diagnosis is based on symptom assessment alone.