Majority of symptoms in esophageal reflux PPI non-responders are not related to reflux

S. Roman, L. Keefer, H. Imam, P. Korrapati, B. Mogni, K. Eident, L. Friesen, P. J. Kahrilas, Z. Martinovich, John E. Pandolfino*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

60 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1667-1674
Number of pages8
JournalNeurogastroenterology and Motility
Issue number11
StatePublished - Nov 2015


  • Gastro-esophageal reflux disease
  • PH-impedance monitoring
  • Proton pump inhibitors
  • Symptom

ASJC Scopus subject areas

  • Endocrine and Autonomic Systems
  • Gastroenterology
  • Physiology


Dive into the research topics of 'Majority of symptoms in esophageal reflux PPI non-responders are not related to reflux'. Together they form a unique fingerprint.

Cite this