PMID- 32122112
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231104
IS  - 2093-0879 (Print)
IS  - 2093-0887 (Electronic)
IS  - 2093-0879 (Linking)
VI  - 26
IP  - 4
DP  - 2020 Sep 30
TI  - High-resolution Manometry Determinants of Refractoriness of Reflux Symptoms to 
      Proton Pump Inhibitor Therapy.
PG  - 447-454
LID - 10.5056/jnm19153 [doi]
AB  - BACKGROUND/AIMS: Impaired esophageal motility and disrupted esophagogastric 
      junction (EGJ) on high-resolution manometry (HRM) have been associated with 
      increased reflux severity in gastroesophageal reflux disease (GERD) patients. 
      However, there are limited data evaluating HRM parameters in proton pump 
      inhibitors (PPI) non-responders. METHODS: Clinical and endoscopic data, HRM and 
      multichannel intraluminal impedance-pH studies performed of PPI therapy in 
      patients with typical GERD symptoms were reviewed from 3 international centers. 
      Frequency of GERD symptoms was assessed on and off PPI therapy in both 
      non-responders (< 50% symptom improvement on PPI therapy) and responders. Rome IV 
      definitions identified non-erosive reflux disease, reflux hypersensitivity, and 
      functional heartburn. Univariate and multivariate analyses were performed to 
      determine predictors of non-response. RESULTS: Of 204 patients, 105 were PPI 
      non-responders and 99 were responders. Non-responders showed higher EGJ 
      contractile integral values, and a lower frequency of type II and III EGJ 
      morphology (P </= 0.03 for each comparison). Esophageal body diagnoses on HRM 
      (fragmented peristalsis, ineffective esophageal motility, or absent peristalsis) 
      did not predict non-response. On multivariate analysis, non-pathological acid 
      exposure time (OR, 2.5; 95% CI, 1.2-5.0; P < 0.001), normal mean nocturnal 
      baseline impedance values (OR, 2.7-2.4; 95% CI, 1.0-6.1; P < 0.05), normal EGJ 
      contractile integral values (OR, 3; 95% CI, 1.3-7.4; P = 0.012), and presence of 
      type I EGJ morphology (OR, 1.9; 95% CI, 1.0-3.4; P = 0.044) were associated with 
      an unfavorable response to PPIs. CONCLUSIONS: Intact EGJ metrics on HRM 
      complement normal reflux burden in predicting non-response to PPI therapy. HRM 
      has value in the evaluation of PPI non-responders.
FAU - Ribolsi, Mentore
AU  - Ribolsi M
AUID- ORCID: 0000-0001-5102-1758
AD  - Unit of Gastroenterology, Campus Bio Medico University, Rome, Italy.
FAU - Savarino, Edoardo
AU  - Savarino E
AD  - Division of Gastroenterology, Department of Surgical, Oncological and 
      Gastroenterological Sciences, University of Padua, Padua, Italy.
FAU - Rogers, Benjamin
AU  - Rogers B
AD  - Division of Gastroenterology, Department of Medicine, Washington University 
      School of Medicine, St. Louis, MO, USA.
FAU - Rengarajan, Arvind
AU  - Rengarajan A
AD  - Division of Gastroenterology, Department of Medicine, Washington University 
      School of Medicine, St. Louis, MO, USA.
FAU - Coletta, Marco Della
AU  - Coletta MD
AD  - Division of Gastroenterology, Department of Surgical, Oncological and 
      Gastroenterological Sciences, University of Padua, Padua, Italy.
FAU - Ghisa, Matteo
AU  - Ghisa M
AD  - Division of Gastroenterology, Department of Surgical, Oncological and 
      Gastroenterological Sciences, University of Padua, Padua, Italy.
FAU - Cicala, Michele
AU  - Cicala M
AD  - Unit of Gastroenterology, Campus Bio Medico University, Rome, Italy.
FAU - Gyawali, C Prakash
AU  - Gyawali CP
AD  - Division of Gastroenterology, Department of Medicine, Washington University 
      School of Medicine, St. Louis, MO, USA.
LA  - eng
PT  - Journal Article
PL  - Korea (South)
TA  - J Neurogastroenterol Motil
JT  - Journal of neurogastroenterology and motility
JID - 101530189
PMC - PMC7547194
OTO - NOTNLM
OT  - Esophagogastric junction
OT  - Gastroesophageal reflux
OT  - Heartburn
OT  - Manometry
OT  - Proton pump inhibitors
COIS- Conflicts of interest: Edoardo Savarino participated in consulting (Allergan, 
      MSD, Takeda, Sofar, and Janssen) and teaching and speaking (Medtronic, 
      Reckitt-Benckiser, Malesci, and Zambon); and C Prakash Gyawali participated in 
      consulting (Ironwood, Torax, and Quintiles) and Teaching and speaking (Medtronic 
      and Diversatek).
EDAT- 2020/03/04 06:00
MHDA- 2020/03/04 06:01
PMCR- 2020/09/30
CRDT- 2020/03/04 06:00
PHST- 2019/08/12 00:00 [received]
PHST- 2019/10/11 00:00 [revised]
PHST- 2019/11/25 00:00 [accepted]
PHST- 2020/03/04 06:00 [pubmed]
PHST- 2020/03/04 06:01 [medline]
PHST- 2020/03/04 06:00 [entrez]
PHST- 2020/09/30 00:00 [pmc-release]
AID - jnm19153 [pii]
AID - JNM-26-447 [pii]
AID - 10.5056/jnm19153 [doi]
PST - ppublish
SO  - J Neurogastroenterol Motil. 2020 Sep 30;26(4):447-454. doi: 10.5056/jnm19153.