Gastro-esophageal reflux and antisecretory drugs use among patients with chronic autoimmune atrophic gastritis: a study with pH-impedance monitoring.

Background Patients with chronic autoimmune atrophic gastritis ( CAAG) often refer digestive symptoms and are prescribed antisecretory medications. Aims were to investigate: (i) gastro-esophageal reflux ( GER), (ii) psychopathological profile, (iii) frequency of use and clinical benefit of antisecretory drugs. Methods Prospective observational study on 41 CAAG patients who underwent: 24 h multichannel intra-luminal impedance-pH ( MII-pH) monitoring off-therapy, standardized medical interview and psychological questionnaire (i.e., SCL-90R). The medical interview was repeated at least 1 month after MII-pH in patients who were using antisecretory drugs. Statistical analysis was performed calculating median (10th-90th percentiles) and risk ratios ( RR) with 95% confidence interval. Key Results Median intra-gastric pH was 6.2 (4.6-7.0). One patient had acid reflux ( AC) associated with symptoms, five had increased total reflux number and four had symptoms associated to non-acid reflux ( NA) (patients referred as ' GER positive'). Using patients ' GER negative' with normal SCL-90R as reference, the RR of being symptomatic in patients GER positive was 2.1 (1.1-4.1) if SCL-90R was normal and 0.9 (0.5-1.7) if it was altered (difference in RR significant being p = 0.04). Seventeen/28 (61%) symptomatic patients were on antisecretory drugs, which were stopped in 16 of them according to results of MII-pH and clinical evaluation after 574 days (48-796) showed that symptoms were unchanged. Conclusions & Inferences In patients with CAAG (i) AC reflux rarely occurred whereas increased NA reflux was not infrequent both being related to symptoms in some patients, (ii) psychopathological profile has a role in symptoms' occurrence, (iii) antisecretory drugs were generally inappropriately used and clinically ineffective. [ABSTRACT FROM AUTHOR]