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[Trial therapy with proton pump inhibitors is not a suitable test for gastroesophageal reflux disease; a meta-analysis of the diagnostic test characteristics].

OBJECTIVE
To determine the value of successful trial therapy with proton-pump inhibitors (PPIs) as a diagnostic test for gastro-oesophageal reflux disease (GERD).


DESIGN
Systematic review and meta-analysis.


METHOD
Studies were included in which the clinical response to a short course (1-4 weeks) of PPI therapy could be related to abnormal results of 24-hr pH monitoring, gastroscopy, and/or diagnostic questionnaires. The sensitivity and specificity of the trial therapy were calculated. The ROC method was used to summarize the test characteristics across studies.


RESULTS
With 24-hr pH monitoring as the reference standard, the positive likelihood ratio of the diagnosis 'reflux disease' ranged from 1.63 to 1.87 and the combined estimates of sensitivity and specificity in the various studies were 0.78 (95% CI: 0.66-0.86) and 0.54 (0.44-0.65), respectively. These values were lower with the other reference standards.


CONCLUSION
Although there were insufficient data to determine the effect of varying dosages of PPIs and duration of therapy on the test characteristics, successful short-term treatment with PPIs in patients suspected of having GERD provides insufficient certainty as to the diagnosis.