Title: Is empiric proton pump inhibition in patients with symptoms of extraesophageal
gastroesophageal reflux justified?
Version: 1 Date: 23 Jul 2023
Reviewer's report:
In this mini review, the authors argued over empiric PPI treatment for extraesophageal reflux
symptoms describing the pathophysiology of EE symptoms in GERD, the limitation of its
accurate diagnosis, and the pros and cons of empiric PPI treatment for EE symptoms. They
concluded that impedance-pH monitoring should be performed for patients having possible
GERD-related EE symptom rather than empiric PPI treatment because the disadvantages of PPI
treatment seem to outweigh the advantages. My comments are as below.
Major comments:
In “Gastroesophageal reflux disease and extraesophageal manifestations”,
The diagnosis of GERD is also defined in Montreal classification and Rome IV. The first
sentence needs to be modified.
Obesity is one of the risk factors of GERD, but it has not been proved whether obesity is the
predominant cause.
In conclusions, it is understanding that PPI trial for possible EE symptoms of GERD do not
have enough evidence to be supported as discussed in this manuscript. However, they cannot
conclude that “The current knowledge suggests that diagnostic testing with pH and impedance
monitoring rather than empiric PPI treatment should be chosen in a higher proportion of patients
presenting with symptoms possibly attributable to EE reflux.”. That is because the diagnosis
of EE in GERD is currently challenging even if using impedance-pH monitoring. Moreover,
there has been little data pertaining to which strategy is more cost effective, diagnostic test-first
strategy or empiric PPIs. The conclusion should be changed completely.
Minor comments:
The manuscript needs to be corrected grammatically.
Title: Is empiric proton pump inhibition in patients with symptoms of extraesophageal
gastroesophageal reflux justified?
Version: 1 Date: 23 Jul 2023
Reviewer's report:
In this mini review, the authors argued over empiric PPI treatment for extraesophageal reflux
symptoms describing the pathophysiology of EE symptoms in GERD, the limitation of its
accurate diagnosis, and the pros and cons of empiric PPI treatment for EE symptoms. They
concluded that impedance-pH monitoring should be performed for patients having possible
GERD-related EE symptom rather than empiric PPI treatment because the disadvantages of PPI
treatment seem to outweigh the advantages. My comments are as below.
Major comments:
In “Gastroesophageal reflux disease and extraesophageal manifestations”,
The diagnosis of GERD is also defined in Montreal classification and Rome IV. The first
sentence needs to be modified.
Obesity is one of the risk factors of GERD, but it has not been proved whether obesity is the
predominant cause.
In conclusions, it is understanding that PPI trial for possible EE symptoms of GERD do not
have enough evidence to be supported as discussed in this manuscript. However, they cannot
conclude that “The current knowledge suggests that diagnostic testing with pH and impedance
monitoring rather than empiric PPI treatment should be chosen in a higher proportion of patients
presenting with symptoms possibly attributable to EE reflux.”. That is because the diagnosis
of EE in GERD is currently challenging even if using impedance-pH monitoring. Moreover,
there has been little data pertaining to which strategy is more cost effective, diagnostic test-first
strategy or empiric PPIs. The conclusion should be changed completely.
Minor comments:
The manuscript needs to be corrected grammatically.
Please review this paper.
user
Title: Is empiric proton pump inhibition in patients with symptoms of extraesophageal
gastroesophageal reflux justified?
Version: 1 Date: 23 Jul 2023
Reviewer's report:
In this mini review, the authors argued over empiric PPI treatment for extraesophageal reflux
symptoms describing the pathophysiology of EE symptoms in GERD, the limitation of its
accurate diagnosis, and the pros and cons of empiric PPI treatment for EE symptoms. They
concluded that impedance-pH monitoring should be performed for patients having possible
GERD-related EE symptom rather than empiric PPI treatment because the disadvantages of PPI
treatment seem to outweigh the advantages. My comments are as below.
Major comments:
In “Gastroesophageal reflux disease and extraesophageal manifestations”,
The diagnosis of GERD is also defined in Montreal classification and Rome IV. The first
sentence needs to be modified.
Obesity is one of the risk factors of GERD, but it has not been proved whether obesity is the
predominant cause.
In conclusions, it is understanding that PPI trial for possible EE symptoms of GERD do not
have enough evidence to be supported as discussed in this manuscript. However, they cannot
conclude that “The current knowledge suggests that diagnostic testing with pH and impedance
monitoring rather than empiric PPI treatment should be chosen in a higher proportion of patients
presenting with symptoms possibly attributable to EE reflux.”. That is because the diagnosis
of EE in GERD is currently challenging even if using impedance-pH monitoring. Moreover,
there has been little data pertaining to which strategy is more cost effective, diagnostic test-first
strategy or empiric PPIs. The conclusion should be changed completely.
Minor comments:
The manuscript needs to be corrected grammatically.
assistant