PMID- 20680164
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20110714
LR  - 20211020
IS  - 2093-0887 (Electronic)
IS  - 2093-0879 (Print)
IS  - 2093-0879 (Linking)
VI  - 16
IP  - 3
DP  - 2010 Jul
TI  - The role of weakly acidic reflux in proton pump inhibitor failure, has dust 
      settled?
PG  - 258-64
LID - 10.5056/jnm.2010.16.3.258 [doi]
AB  - Patients that do not respond satisfactorily to standard proton pump inhibitor 
      (PPI) treatment have become the most common presentation of gastro-esophageal 
      reflux disease (GERD) in third referral gastrointestinal practices. The causes of 
      refractory GERD include lack of compliance with treatment, residual acid reflux 
      and weakly acidic reflux, esophageal hypersensitivity and persistent symptoms not 
      associated with reflux. A role for weakly acidic reflux in symptom generation has 
      been proposed since the availability of impedance-pH monitoring. The possible 
      mechanisms by which persistent weakly acidic reflux might contribute to 
      persistent symptoms in patients under PPI treatment may include esophageal 
      distension by increased reflux volume, persistent impaired mucosal integrity (ie, 
      dilation of intercellular spaces) and/or esophageal hypersensitivity to weakly 
      acidic reflux events. To establish a definite role of weakly acidic reflux in 
      refractory GERD, outcome studies targeting this type of reflux are still lacking. 
      Treatment strategies to reduce the number or effect of weakly acidic reflux could 
      involve drugs that decrease transient lower esophageal sphincter relaxations (ie, 
      baclofen or similar), improve oesophageal mucosa resistance or visceral pain 
      modulators. Finally, anti-reflux surgery can be considered, only if a clear 
      symptom-weakly acidic reflux association was demonstrated.
FAU - Tsoukali, Emmanouela
AU  - Tsoukali E
AD  - Barts and The London School of Medicine and Dentistry, Queen Mary, University of 
      London, UK.
FAU - Sifrim, Daniel
AU  - Sifrim D
LA  - eng
PT  - Journal Article
DEP - 20100727
PL  - Korea (South)
TA  - J Neurogastroenterol Motil
JT  - Journal of neurogastroenterology and motility
JID - 101530189
PMC - PMC2912118
OTO - NOTNLM
OT  - Gastric
OT  - Gastrooesophageal reflux
OT  - Heartburn
OT  - Proton pump inhibitors
OT  - Regurgitation
COIS- Conflicts of interest: None.
EDAT- 2010/08/04 06:00
MHDA- 2010/08/04 06:01
PMCR- 2010/07/01
CRDT- 2010/08/04 06:00
PHST- 2010/05/21 00:00 [received]
PHST- 2010/06/15 00:00 [revised]
PHST- 2010/06/24 00:00 [accepted]
PHST- 2010/08/04 06:00 [entrez]
PHST- 2010/08/04 06:00 [pubmed]
PHST- 2010/08/04 06:01 [medline]
PHST- 2010/07/01 00:00 [pmc-release]
AID - 10.5056/jnm.2010.16.3.258 [doi]
PST - ppublish
SO  - J Neurogastroenterol Motil. 2010 Jul;16(3):258-64. doi: 
      10.5056/jnm.2010.16.3.258. Epub 2010 Jul 27.