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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
biochemistry, genetics and molecular biology
Majority of symptoms in esophageal reflux PPI non-responders are not related to reflux
Neurogastroenterology and Motility, Volume 27, No. 11, Year 2015
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Description
Background: Genesis of persistent gastro-esophageal reflux symptoms despite proton pump inhibitor (PPI) therapy is not fully understood. We aimed at determining reflux patterns on 24-h pH-impedance monitoring performed on PPI and correlating impedance patterns and symptom occurrence in PPI non-responders. Methods: Seventy-eight PPI non-responder patients underwent 24-h pH-impedance monitoring on PPI. Reflux impedance characterization included gastric and supragastric belches and proximal extent of reflux. Symptoms were considered associated with reflux if occurring within 5 min after a reflux event. Patients were classified into three groups: persistent acid reflux (acid esophageal exposure [AET] >5% of time), reflux sensitivity (AET <5%, symptom index [SI] ≥50%), and functional symptoms (AET <5%, SI <50%). Dominant impedance pattern was determined for each patient. Key Results: Seven patients (9%) had persistent acid reflux, 28 (36%) reflux sensitivity, and 43 (55%) functional symptoms. A total of 4296 reflux events were identified (median per patient 45 [range 4-221]). Although liquid reflux was the most common pattern in all groups, patients with reflux sensitivity and functional symptoms had much more variability in their pattern profile with a large proportion being associated with gastric and supragastric belching. Only 417 reflux events (9.7%) were associated with symptoms. Reflux with a supragastric component and proximal extent were more likely to be associated with symptoms. Conclusions & Inferences: The impedance reflux profile in PPI non-responders was heterogeneous and the majority of reflux events were not associated with symptoms. Thus, the treatment of PPI non-responders should focus on mechanisms beyond reflux, such as visceral hypersensitivity and hypervigilance. © 2015 John Wiley
Authors & Co-Authors
Roman, Sabine
United States, Chicago
Northwestern University Feinberg School of Medicine
France, Villeurbanne
Université Claude Bernard Lyon 1
Keefer, Laurie A.
United States, Chicago
Northwestern University Feinberg School of Medicine
Imam, H.
United States, Chicago
Northwestern University Feinberg School of Medicine
Egypt, Asyut
Assiut University
Korrapati, P.
United States, Chicago
Northwestern University Feinberg School of Medicine
Mogni, B.
United States, Chicago
Northwestern University Feinberg School of Medicine
Eident, K.
United States, Chicago
Northwestern University Feinberg School of Medicine
Friesen, L.
United States, Chicago
Northwestern University Feinberg School of Medicine
Kahrilas, P. J.
United States, Chicago
Northwestern University Feinberg School of Medicine
Martinovich, Z.
United States, Chicago
Northwestern University Feinberg School of Medicine
Pandolfino, John E.
United States, Chicago
Northwestern University Feinberg School of Medicine
Statistics
Citations: 68
Authors: 10
Affiliations: 3
Identifiers
Doi:
10.1111/nmo.12666
ISSN:
13501925
e-ISSN:
13652982
Research Areas
Health System And Policy