Review article: how valuable are proton‐pump inhibitors in establishing a diagnosis of gastro‐oesophageal reflux disease?

Diagnostic studies for gastro-oesophageal reflux disease (endoscopy, pH testing) have significant limitations. A short trial of acid suppression with a proton-pump inhibitor is often used in clinical practice as a diagnostic test for gastro-oesophageal reflux disease. If there is a significant improvement in symptoms, the patient is considered to have gastro-oesophageal reflux disease. Several studies have evaluated the administration of proton-pump inhibitors as a diagnostic test for gastro-oesophageal reflux disease. A recent meta-analysis found that response to a proton-pump inhibitor had limited value as a diagnostic test. Likelihood ratios for a positive test ranged from 0.45 to 1.86. The positive predictive value of the test ranged from 0.17 to 0.90 and the negative predictive value from 0.17 to 1, depending on the gold standard against which comparisons were made. These results may be explained by the inadequacy of the gold standard against which the proton-pump inhibitor test is compared or by the inability of acid suppression to differentiate between gastro-oesophageal reflux disease, peptic ulcer disease or dyspepsia. Although a trial of acid suppression may have pragmatic value in clinical practice, the proton-pump inhibitor test is not an accurate test for the diagnosis of gastro-oesophageal reflux disease.