PMID- 25273120
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20141002
LR  - 20220310
IS  - 2093-0879 (Print)
IS  - 2093-0887 (Electronic)
IS  - 2093-0879 (Linking)
VI  - 20
IP  - 4
DP  - 2014 Oct 30
TI  - Diagnostic Utility of Impedance-pH Monitoring in Refractory Non-erosive Reflux 
      Disease.
PG  - 497-505
LID - 10.5056/jnm14038 [doi]
AB  - BACKGROUND/AIMS: Approximately one-third of non-erosive reflux disease (NERD) 
      patients are refractory to proton pump inhibitors (PPI) and face a therapeutic 
      challenge. Therefore, it is important to differentiate between pathological and 
      non-pathological reflux utilizing multichannel intraluminal impedance-pH (MII-pH) 
      to analyze symptom-reflux association and diagnose true NERD versus 
      hyper-sensitive esophagus (HE) and functional heartburn (FH). Herein, we 
      evaluated the diagnostic yield of MII-pH in refractory NERD and sub-classified it 
      based on quantity and quality of acid/non-acid reflux and reflux-symptom 
      association. METHODS: Sixty symptomatic NERD patients on twice daily PPI for > 2 
      months were prospectively evaluated by MII-pH. Distal and prox-imal refluxes, 
      bolus exposure time (BET), esophageal acid exposure time, symptom index (SI) and 
      symptom association proba-bility (SAP) were measured. RESULTS: Thirty-two (53%) 
      patients had BET > 1.4% (MII-pH positive-true NERD), while 28 (47%) had BET < 
      1.4% (MII-pH negative NERD) where SI and SAP were negative in 15/60 (25%; 
      categorized as FH) and SI or SAP were positive in 13/60 (22%; identi-fied as HE). 
      Thirty-eight (63%) patients reported significant SI or SAP parameters where > 80% 
      of symptoms were associated with non-acid reflux. The number of distal refluxes 
      in true NERD versus FH or HE were significantly different, but not between FH and 
      HE. CONCLUSIONS: Approximately 60% of refractory PPI NERD patients had positive 
      reflux-symptom association, primarily due to non-acid reflux. Nearly half of NERD 
      patients on PPI had normal MII-pH monitoring, sub-divided further into FH and HE 
      equally.(J Neurogastroenterol Motil 2014;20:497-505).
FAU - Khan, Mohammed Q
AU  - Khan MQ
AD  - Section of Gastroenterology, Department of Medicine, King Faisal Specialist 
      Hospital and Research Center, Riyadh, Saudi Arabia.
FAU - Alaraj, Ali
AU  - Alaraj A
AD  - Section of Gastroenterology, Department of Medicine, King Faisal Specialist 
      Hospital and Research Center, Riyadh, Saudi Arabia.
FAU - Alsohaibani, Fahad
AU  - Alsohaibani F
AD  - Section of Gastroenterology, Department of Medicine, King Faisal Specialist 
      Hospital and Research Center, Riyadh, Saudi Arabia.
FAU - Al-Kahtani, Khalid
AU  - Al-Kahtani K
AD  - Section of Gastroenterology, Department of Medicine, King Faisal Specialist 
      Hospital and Research Center, Riyadh, Saudi Arabia.
FAU - Jbarah, Sahar
AU  - Jbarah S
AD  - Section of Gastroenterology, Department of Medicine, King Faisal Specialist 
      Hospital and Research Center, Riyadh, Saudi Arabia.
FAU - Al-Ashgar, Hamad
AU  - Al-Ashgar H
AD  - Section of Gastroenterology, Department of Medicine, King Faisal Specialist 
      Hospital and Research Center, Riyadh, Saudi Arabia.
LA  - eng
PT  - Journal Article
PL  - Korea (South)
TA  - J Neurogastroenterol Motil
JT  - Journal of neurogastroenterology and motility
JID - 101530189
PMC - PMC4204403
OTO - NOTNLM
OT  - Impedance-pH monitoring
OT  - Non-erosive reflux disease
OT  - Refractory NERD
EDAT- 2014/10/03 06:00
MHDA- 2014/10/03 06:01
PMCR- 2014/10/01
CRDT- 2014/10/03 06:00
PHST- 2014/04/02 00:00 [received]
PHST- 2014/06/17 00:00 [revised]
PHST- 2014/06/18 00:00 [accepted]
PHST- 2014/10/03 06:00 [entrez]
PHST- 2014/10/03 06:00 [pubmed]
PHST- 2014/10/03 06:01 [medline]
PHST- 2014/10/01 00:00 [pmc-release]
AID - jnm.20.497 [pii]
AID - jnm-20-497 [pii]
AID - 10.5056/jnm14038 [doi]
PST - ppublish
SO  - J Neurogastroenterol Motil. 2014 Oct 30;20(4):497-505. doi: 10.5056/jnm14038.