PMID- 18775017
OWN - NLM
STAT- MEDLINE
DCOM- 20081231
LR  - 20220317
IS  - 1572-0241 (Electronic)
IS  - 0002-9270 (Linking)
VI  - 103
IP  - 11
DP  - 2008 Nov
TI  - The role of nonacid reflux in NERD: lessons learned from impedance-pH monitoring 
      in 150 patients off therapy.
PG  - 2685-93
LID - 10.1111/j.1572-0241.2008.02119.x [doi]
AB  - INTRODUCTION: Nonerosive reflux disease (NERD) is the most common form of 
      gastroesophageal reflux disease. While the role of acid reflux has been 
      established, the relevance of nonacid reflux in generating symptoms in NERD is 
      unknown. AIM: To evaluate the diagnostic utility of impedance-pH monitoring in 
      NERD patients. METHODS: Patients with typical reflux symptoms (heartburn and/or 
      regurgitation) and normal endoscopy (NERD) underwent a combined impedance-pH 
      monitoring off proton pump inhibitor (PPI) therapy. Previously investigated 48 
      healthy volunteers served as controls. Distal esophageal acid exposure (% time pH 
      < 4), number of acid and nonacid reflux episodes, 2-min window symptom index (SI; 
      positive if > or = 50%), and symptom association probability (SAP; positive if > 
      or = 95%) were calculated. RESULTS: Between June 2004 and June 2007, 150 NERD 
      patients (82 women, mean age 48 yr, range 18-78 yr) reported symptoms during the 
      impedance-pH monitoring. NERD patients had more reflux episodes (median 
      [25th-75th percentile]) compared with healthy volunteers (total: 46 [26-65] vs 32 
      [18-43], P < 0.05; acid: 29 [14-43] vs 17 [8.5-31.0], P < 0.05; and nonacid: 20 
      [15-27] vs 18 [13.5-26.0], P = NS). Sixty-three (42%) patients had abnormal % 
      time pH < 4. Among 87 patients with normal % time pH < 4., 22 (15%) had a 
      positive SAP for acid, 19 (12%) for nonacid reflux, and 7 (5%) for both. 
      Classifying patients with symptomatic nonacid reflux as having a hypersensitive 
      esophagus reduced the number of patients with functional heartburn from 65 (43%) 
      to 39 (26%). CONCLUSION: Monitoring for nonacid reflux in NERD patients reduces 
      the proportion of patients classified as having "functional heartburn." Studies 
      assessing the clinical implications of these findings are warranted.
FAU - Savarino, Edoardo
AU  - Savarino E
AD  - Di.M.I. Cattedra di Gastroenterologia, Universita di Genova, Genova, Italy.
FAU - Zentilin, Patrizia
AU  - Zentilin P
FAU - Tutuian, Radu
AU  - Tutuian R
FAU - Pohl, Daniel
AU  - Pohl D
FAU - Casa, Domenico D
AU  - Casa DD
FAU - Frazzoni, Marzio
AU  - Frazzoni M
FAU - Cestari, Renzo
AU  - Cestari R
FAU - Savarino, Vincenzo
AU  - Savarino V
LA  - eng
PT  - Journal Article
DEP - 20080904
PL  - United States
TA  - Am J Gastroenterol
JT  - The American journal of gastroenterology
JID - 0421030
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Endoscopy, Digestive System
MH  - *Esophageal pH Monitoring
MH  - Female
MH  - Gastroesophageal Reflux/*diagnosis/etiology/physiopathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Young Adult
EDAT- 2008/09/09 09:00
MHDA- 2009/01/01 09:00
CRDT- 2008/09/09 09:00
PHST- 2008/09/09 09:00 [pubmed]
PHST- 2009/01/01 09:00 [medline]
PHST- 2008/09/09 09:00 [entrez]
AID - AJG2119 [pii]
AID - 10.1111/j.1572-0241.2008.02119.x [doi]
PST - ppublish
SO  - Am J Gastroenterol. 2008 Nov;103(11):2685-93. doi: 
      10.1111/j.1572-0241.2008.02119.x. Epub 2008 Sep 4.