Long-Term Reflux Outcomes–A Pragmatic Study of Mucosal Integrity Testing

Background and Aims: Mucosal integrity testing (MI) is a diagnostic modality for gastroesophageal reflux disease (GERD). The aim of this study was to evaluate whether MI predicted long-term improvement in reflux symptoms and the ability to discontinue proton pump inhibitors (PPIs). Methods: Patients with suspected GERD who underwent MI with (N=86) or without (N=25) wireless pH capsule placement were studied. The GERD-questionnaire (GERD-Q) and GERD health-related quality of life (GERD-HRQL) were administered at follow-up. Logistic regression models were used to estimate the predicted probability of reflux resolution and PPI discontinuation. Key Results: Complete resolution (CR) occurred in 73% (81/111), while reflux remained partially resolved (PR) in 27% (30/111) at a median follow-up of 2.5 years. In the CR group, 33% (27/81) no longer required PPI therapy compared with 13% (4/30) in the PR group. Median (IQR) MI patterns of change over distance from the squamocolumnar junction differed in the 2 groups with the CR group having a higher intercept (4130 Ω vs. 3045 Ω, P <0.01) and flatter slope (71 Ω/cm vs. 224 Ω/cm, P <0.01). MI (C-index 0.71) was better than pH (C-index 0.49) at predicting long-term resolution of reflux in this cohort. Conclusions and Inferences: This is the first outcome-based study to show that changes in MI can predict long-term outcomes. One in 3 patients with higher mucosal impedance (suggesting normal mucosal integrity) can discontinue PPIs long-term.