PMID- 25632912
OWN - NLM
STAT- MEDLINE
DCOM- 20150930
LR  - 20150130
IS  - 1421-9867 (Electronic)
IS  - 0012-2823 (Linking)
VI  - 91
IP  - 1
DP  - 2015
TI  - Evaluation of proton pump inhibitor-resistant nonerosive reflux disease by 
      esophageal manometry and 24-hour esophageal impedance and pH monitoring.
PG  - 19-25
LID - 10.1159/000368766 [doi]
AB  - BACKGROUND: Patients with proton pump inhibitor (PPI)-resistant nonerosive reflux 
      disease (NERD) include subgroups that have markedly different pathophysiology. 
      This study aimed to clarify the pathophysiology of NERD by esophageal manometry 
      with 24-hour esophageal impedance and pH monitoring. METHODS: Eighteen 
      consecutive outpatients referred to our expert center for functional 
      gastrointestinal motility with suspected PPI-resistant NERD were enrolled. 
      Manometry was performed to detect esophageal motility disorders. Subsequently, 
      24-hour esophageal impedance and pH monitoring was done while patients were on 
      PPI therapy. RESULTS: Manometry revealed 1 case of achalasia, 1 case of 
      nutcracker esophagus and 3 cases of diffuse esophageal spasm. Three patients had 
      ineffective esophageal motility, with impedance and pH monitoring being performed 
      in 2 of them. Esophageal acid exposure (%time pH <4) was normal in both, but the 
      symptom index (SI) was positive for nonacidic reflux in 1 patient. One of the 10 
      patients with normal esophageal motility had abnormal esophageal acid exposure. 
      The SI was positive for weakly acidic and nonacidic reflux in 3 of the remaining 
      9 patients with normal esophageal acid exposure. Five of the other 6 patients 
      seemed to have functional heartburn. CONCLUSION: A substantial percentage (28%) 
      of patients with suspected PPI-resistant NERD had primary esophageal motility 
      disorders. Both nonacidic reflux and weakly acidic reflux are important 
      contributors to the symptoms of patients with PPI-resistant NERD. Esophageal 
      manometry is required to exclude motility disorders, while 24-hour esophageal 
      impedance and pH monitoring is invaluable for assessing symptom-reflux 
      associations and the indications for fundoplication in patients with suspected 
      PPI-resistant NERD.
CI  - (c) 2015 S. Karger AG, Basel.
FAU - Kawamura, Osamu
AU  - Kawamura O
AD  - Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, 
      Maebashi, Japan.
FAU - Hosaka, Hiroko
AU  - Hosaka H
FAU - Shimoyama, Yasuyuki
AU  - Shimoyama Y
FAU - Kawada, Akiyo
AU  - Kawada A
FAU - Kuribayashi, Shiko
AU  - Kuribayashi S
FAU - Kusano, Motoyasu
AU  - Kusano M
FAU - Yamada, Masanobu
AU  - Yamada M
LA  - eng
PT  - Journal Article
DEP - 20150120
PL  - Switzerland
TA  - Digestion
JT  - Digestion
JID - 0150472
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Diagnostic Techniques, Digestive System
MH  - Drug Resistance
MH  - Electric Impedance
MH  - Electrodiagnosis/*methods
MH  - Esophageal Motility Disorders/*diagnosis/surgery
MH  - *Esophageal pH Monitoring
MH  - Esophagus/physiopathology
MH  - Female
MH  - Fundoplication
MH  - Gastroesophageal Reflux/diagnosis/drug therapy/*physiopathology
MH  - Humans
MH  - Male
MH  - Manometry/*methods
MH  - Middle Aged
MH  - Proton Pump Inhibitors/therapeutic use
EDAT- 2015/01/31 06:00
MHDA- 2015/10/01 06:00
CRDT- 2015/01/31 06:00
PHST- 2015/01/31 06:00 [entrez]
PHST- 2015/01/31 06:00 [pubmed]
PHST- 2015/10/01 06:00 [medline]
AID - 000368766 [pii]
AID - 10.1159/000368766 [doi]
PST - ppublish
SO  - Digestion. 2015;91(1):19-25. doi: 10.1159/000368766. Epub 2015 Jan 20.