PMID- 26337396 OWN - NLM STAT- MEDLINE DCOM- 20160826 LR - 20181113 IS - 1365-2982 (Electronic) IS - 1350-1925 (Print) IS - 1350-1925 (Linking) VI - 27 IP - 11 DP - 2015 Nov TI - Majority of symptoms in esophageal reflux PPI non-responders are not related to reflux. PG - 1667-74 LID - 10.1111/nmo.12666 [doi] AB - BACKGROUND: Genesis of persistent gastro-esophageal reflux symptoms despite proton pump inhibitor (PPI) therapy is not fully understood. We aimed at determining reflux patterns on 24-h pH-impedance monitoring performed on PPI and correlating impedance patterns and symptom occurrence in PPI non-responders. METHODS: Seventy-eight PPI non-responder patients underwent 24-h pH-impedance monitoring on PPI. Reflux impedance characterization included gastric and supragastric belches and proximal extent of reflux. Symptoms were considered associated with reflux if occurring within 5 min after a reflux event. Patients were classified into three groups: persistent acid reflux (acid esophageal exposure [AET] >5% of time), reflux sensitivity (AET <5%, symptom index [SI] >/=50%), and functional symptoms (AET <5%, SI <50%). Dominant impedance pattern was determined for each patient. KEY RESULTS: Seven patients (9%) had persistent acid reflux, 28 (36%) reflux sensitivity, and 43 (55%) functional symptoms. A total of 4296 reflux events were identified (median per patient 45 [range 4-221]). Although liquid reflux was the most common pattern in all groups, patients with reflux sensitivity and functional symptoms had much more variability in their pattern profile with a large proportion being associated with gastric and supragastric belching. Only 417 reflux events (9.7%) were associated with symptoms. Reflux with a supragastric component and proximal extent were more likely to be associated with symptoms. CONCLUSIONS & INFERENCES: The impedance reflux profile in PPI non-responders was heterogeneous and the majority of reflux events were not associated with symptoms. Thus, the treatment of PPI non-responders should focus on mechanisms beyond reflux, such as visceral hypersensitivity and hypervigilance. CI - (c) 2015 John Wiley & Sons Ltd. FAU - Roman, S AU - Roman S AD - Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. AD - Digestive Physiology, Hospices Civils de Lyon, Lyon I university and LabTAU Inserm 1032, Lyon, France. FAU - Keefer, L AU - Keefer L AD - Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. FAU - Imam, H AU - Imam H AD - Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. AD - Gastroenterology and Hepatology Unit, Department of Internal Medicine, Assiut University Hospital, Assiut, Egypt. FAU - Korrapati, P AU - Korrapati P AD - Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. FAU - Mogni, B AU - Mogni B AD - Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. FAU - Eident, K AU - Eident K AD - Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. FAU - Friesen, L AU - Friesen L AD - Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. FAU - Kahrilas, P J AU - Kahrilas PJ AD - Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. FAU - Martinovich, Z AU - Martinovich Z AD - Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. FAU - Pandolfino, J E AU - Pandolfino JE AD - Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. LA - eng GR - R01 DK092217/DK/NIDDK NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20150904 PL - England TA - Neurogastroenterol Motil JT - Neurogastroenterology and motility JID - 9432572 RN - 0 (Proton Pump Inhibitors) SB - IM MH - Adult MH - Aged MH - Drug Resistance/*physiology MH - Electric Impedance MH - Esophageal pH Monitoring MH - Female MH - Gastroesophageal Reflux/*drug therapy/*physiopathology MH - Humans MH - Male MH - Manometry MH - Middle Aged MH - Proton Pump Inhibitors/*therapeutic use MH - Young Adult PMC - PMC4624503 MID - NIHMS714546 OTO - NOTNLM OT - gastro-esophageal reflux disease OT - pH-impedance monitoring OT - proton pump inhibitors OT - symptom COIS- Potential competing interests: Sabine Roman serves as a paid consultant for Given Imaging/Covidien/Medtronic. John E. Pandolfino serves as a paid consultant for AstraZeneca. EDAT- 2015/09/05 06:00 MHDA- 2016/08/27 06:00 PMCR- 2016/11/01 CRDT- 2015/09/05 06:00 PHST- 2015/03/25 00:00 [received] PHST- 2015/08/03 00:00 [accepted] PHST- 2015/09/05 06:00 [entrez] PHST- 2015/09/05 06:00 [pubmed] PHST- 2016/08/27 06:00 [medline] PHST- 2016/11/01 00:00 [pmc-release] AID - 10.1111/nmo.12666 [doi] PST - ppublish SO - Neurogastroenterol Motil. 2015 Nov;27(11):1667-74. doi: 10.1111/nmo.12666. Epub 2015 Sep 4.