PMID- 17951358
OWN - NLM
STAT- MEDLINE
DCOM- 20080212
LR  - 20220330
IS  - 1468-3288 (Electronic)
IS  - 0017-5749 (Linking)
VI  - 57
IP  - 2
DP  - 2008 Feb
TI  - Determinants of gastro-oesophageal reflux perception in patients with persistent 
      symptoms despite proton pump inhibitors.
PG  - 156-60
AB  - BACKGROUND AND AIMS: Approximately 20% of patients have persistent symptoms of 
      gastro-oesophageal reflux despite proton pump inhibitor (PPI) therapy. The aim of 
      this study was to assess the determinants of reflux perception in patients on PPI 
      therapy. PATIENTS AND METHODS: 20 patients with typical gastro-oesophageal reflux 
      symptoms (heartburn and/or regurgitation) despite double-dose PPIs (twice daily) 
      were included in this study. Ambulatory 24 h pH-impedance studies were performed 
      in all patients. The characteristics of symptomatic and asymptomatic reflux 
      episodes were compared. Symptoms were considered globally and separately for 
      heartburn and regurgitation. RESULTS: A total of 1273 reflux episodes were 
      detected including 243 (19.1%) acidic, 1018 (80.0%) weakly acidic and 12 (0.9%) 
      weakly alkaline reflux episodes. Overall, 312 (24.5%) reflux episodes were 
      symptomatic. The only factor associated with reflux perception was high proximal 
      extent (p = 0.037). Compared with regurgitation, reflux episodes associated with 
      heartburn were more frequently pure liquid (p = 0.009) and acidic (p = 0.027), 
      had a lower nadir pH (p<0.001), were more frequently preceded by acid reflux 
      episodes (p<0.001) and had a longer reflux bolus clearance time (p<0.001). 
      CONCLUSIONS: High proximal extent of the refluxate is the only factor associated 
      with reflux perception in patients on double-dose PPI. However, compared with 
      regurgitation, composition of the refluxate, sensitisation of the oesophagus by 
      preceding acid exposure and delayed bolus clearance appear to play a role in 
      heartburn perception.
FAU - Zerbib, F
AU  - Zerbib F
AD  - CHU Bordeaux, Saint Andre Hospital, Gastroenterology Department, Bordeaux, 
      France. frank.zerbib@chu-bordeaux.fr
FAU - Duriez, A
AU  - Duriez A
FAU - Roman, S
AU  - Roman S
FAU - Capdepont, M
AU  - Capdepont M
FAU - Mion, F
AU  - Mion F
LA  - eng
PT  - Journal Article
DEP - 20071019
PL  - England
TA  - Gut
JT  - Gut
JID - 2985108R
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Esophageal pH Monitoring
MH  - Esophagus/*physiology
MH  - Female
MH  - Gastric Acidity Determination
MH  - Gastroesophageal Reflux/*drug therapy/metabolism
MH  - Heartburn/etiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Patient Satisfaction/*statistics & numerical data
MH  - Proton Pump Inhibitors/*therapeutic use
EDAT- 2007/10/24 09:00
MHDA- 2008/02/13 09:00
CRDT- 2007/10/24 09:00
PHST- 2007/10/24 09:00 [pubmed]
PHST- 2008/02/13 09:00 [medline]
PHST- 2007/10/24 09:00 [entrez]
AID - gut.2007.133470 [pii]
AID - 10.1136/gut.2007.133470 [doi]
PST - ppublish
SO  - Gut. 2008 Feb;57(2):156-60. doi: 10.1136/gut.2007.133470. Epub 2007 Oct 19.