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, Peter J Kahrilas, Zoran Martinovich, John Erik Pandolfino*

*Corresponding author for this work

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

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
Volume27
Issue number11
DOIs
StatePublished - Nov 1 2015

Fingerprint

Proton Pump Inhibitors
Gastroesophageal Reflux
Electric Impedance
beta-Aminoethyl Isothiourea
Acids
Stomach
Eructation
Hypersensitivity
Anxiety
Therapeutics

Keywords

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

ASJC Scopus subject areas

  • Physiology
  • Endocrine and Autonomic Systems
  • Gastroenterology

Cite this

Roman, S. ; Keefer, L. ; Imam, H. ; Korrapati, P. ; Mogni, B. ; Eident, K. ; Friesen, L. ; Kahrilas, Peter J ; Martinovich, Zoran ; Pandolfino, John Erik. / Majority of symptoms in esophageal reflux PPI non-responders are not related to reflux. In: Neurogastroenterology and Motility. 2015 ; Vol. 27, No. 11. pp. 1667-1674.
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abstract = "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.",
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author = "S. Roman and L. Keefer and H. Imam and P. Korrapati and B. Mogni and K. Eident and L. Friesen and Kahrilas, {Peter J} and Zoran Martinovich and Pandolfino, {John Erik}",
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Majority of symptoms in esophageal reflux PPI non-responders are not related to reflux. / Roman, S.; Keefer, L.; Imam, H.; Korrapati, P.; Mogni, B.; Eident, K.; Friesen, L.; Kahrilas, Peter J; Martinovich, Zoran; Pandolfino, John Erik.

In: Neurogastroenterology and Motility, Vol. 27, No. 11, 01.11.2015, p. 1667-1674.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Majority of symptoms in esophageal reflux PPI non-responders are not related to reflux

AU - Roman, S.

AU - Keefer, L.

AU - Imam, H.

AU - Korrapati, P.

AU - Mogni, B.

AU - Eident, K.

AU - Friesen, L.

AU - Kahrilas, Peter J

AU - Martinovich, Zoran

AU - Pandolfino, John Erik

PY - 2015/11/1

Y1 - 2015/11/1

N2 - 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.

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.

KW - Gastro-esophageal reflux disease

KW - PH-impedance monitoring

KW - Proton pump inhibitors

KW - Symptom

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