Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy. A multicentre study using combined ambulatory impedance-pH monitoring

Inder Mainie ^1*, Radu Tutuian ¹, Steven Shay ², Marcelo Vela ¹, Xin Zhang ³, Daniel Sifrim ³ and Donald 0 Castell ¹

¹ Medical University South Carolina, United States
² Cleveland Clinic Foundation, United States
³ Catholic University of Leuven, Belgium

^* To whom correspondence should be addressed. E-mail: mainie{at}musc.edu.

Accepted 14 March 2006

Abstract

Background & Aims: Empiric proton pump inhibitor (PPI) trials have become increasingly popular leading to gastroenterologists frequently evaluating GORD patients only after they have "failed" PPI therapy. Combined multichannel intraluminal impedance and pH (MII-pH) monitoring has the ability to detect gastrooesophageal reflux (GOR) episodes independent of their pH and evaluate the relationship between symptoms and all types of GOR. Using this technique we aim to characterize the frequency of acid and non-acid reflux (NAR) and their relationship to typical and atypical GOR symptoms in patients on PPI therapy.

Methods: Patients with persistent GORD symptoms referred to three centers underwent 24-hour combined MII- pH monitoring while taking at least twice daily PPIs. Reflux episodes were detected by impedance channels located 3,5,7,9,15 and 17 cm above the LES and classified into acid or non-acid based on pH data from 5cm above the LES. A positive symptom index (SI) was declared if at least half of the each specific symptom events were preceded by reflux episodes within 5 minutes.

Results: 168 patients (103 (61%) female and 65 (39%) male; mean age 53; range 18 to 85 years) underwent combined MII-pH monitoring while taking at least twice daily PPI. 144 (86%) patients recorded symptoms during the study day and 24 (15%) patients had no symptoms during testing. 69 (48%) of the symptomatic patients had a positive SI for at least one symptom (16 (11%) with acid reflux and 53 (37%) with NAR) and 75 (52%) had a negative SI. 171 (57%) typical GORD symptoms were recorded, 19 (11%) had a +SI for acid reflux, 52 (31%) for NAR and 100 (58%) had a negative SI. 131 (43%) atypical symptoms were recorded, 4 (3%) had a +SI for acid reflux, 25 (19%) had a +SI for NAR, and 102 (78%) a negative SI.

Conclusion: Combined MII-pH identifies the relation of reflux of all types to persistent symptoms and the importance of NAR in patients taking PPIs.

Keywords: gastrooesophageal reflux disease, multi-channel intraluminal impedance and pH, non-acid reflux

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Impedance-pH monitoring in proton pump inhibitor resistant patients: ready for clinical application?

J P Galmiche
Gut 2006 55: 1379-1381. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Fass, R, Sifrim, D (2009). Management of heartburn not responding to proton pump inhibitors. Gut 58: 295-309 [Abstract] [Full Text]  
• Sweet, M P, Patti, M G, Hoopes, C, Hays, S R, Golden, J A (2009). Gastro-oesophageal reflux and aspiration in patients with advanced lung disease. Thorax 64: 167-173 [Abstract] [Full Text]  
• Johnston, N. (2008). Receptor Mediated Uptake of Pepsin: Significance in Otolaryngology. Voice and Voice Disorders 18: 134-142 [Abstract] [Full Text]  
• Fox, M., Schwizer, W. (2008). Making sense of oesophageal contents. Gut 57: 435-438 [Full Text]  
• Blondeau, K., Mertens, V., Vanaudenaerde, B. A., Verleden, G. M., Van Raemdonck, D. E., Sifrim, D., Dupont, L. J. (2008). Gastro-oesophageal reflux and gastric aspiration in lung transplant patients with or without chronic rejection. Eur Respir J 31: 707-713 [Abstract] [Full Text]  
• Zerbib, F, Duriez, A, Roman, S, Capdepont, M, Mion, F (2008). Determinants of gastro-oesophageal reflux perception in patients with persistent symptoms despite proton pump inhibitors. Gut 57: 156-160 [Abstract] [Full Text]  
• McGarvey, L.P.A., Polley, L., MacMahon, J. (2007). Review Series: Chronic cough: Common causes and current guidelines. Chronic Respiratory Disease 4: 215-223 [Abstract]  
• Bredenoord, A. J, Dent, J. (2007). Proton pump inhibitor-therapy refractory gastro-oesophageal reflux disease patients, who are they?. Gut 56: 593-594 [Full Text]  
• Galmiche, J P (2006). Impedance-pH monitoring in proton pump inhibitor resistant patients: ready for clinical application?. Gut 55: 1379-1381 [Full Text]