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Determinants of gastro-oesophageal reflux perception in patients with persistent symptoms despite proton pump inhibitors
  1. Frank Zerbib (frank.zerbib{at}
  1. CHU Bordeaux, France
    1. Arnaud Duriez (aduriez{at}
    1. Bordeaux, France
      1. Sabine Roman (sabine.roman{at}
      1. Hospices Civils de Lyon, France
        1. Maylis Capdepont (maylis.capdepont{at}
        1. CHU Bordeaux, France
          1. Francois Mion (francois.mion{at}
          1. Hospices Civils de Lyon, France


            Background and aim: Approximately 20% of patients have persistent symptoms of gastro-oesophageal reflux (GOR) despite proton pump inhibitors (PPI) therapy. The aim of this study was to assess the determinants of reflux perception in patients on PPI therapy. Patients and methods: Twenty patients with typical GOR symptoms (heartburn and/or regurgitation) despite double dose PPIs (b.i.d) were included in this study. Ambulatory 24-hour pH-impedance studies were performed in all patients. The characteristics of symptomatic and asymptomatic reflux episodes were compared. Symptoms were considered globally and separately for heartburn and regurgitation. Results: A total of 1273 reflux episodes were detected including 243 (19.1%) acidic, 1018 (80.0%) weakly acidic and 12 (0.9%) weakly alkaline reflux episodes. Overall, 312 (24.5%) reflux episodes were symptomatic. The only factor associated with reflux perception was high proximal extent (p = 0.037). Compared to regurgitation, reflux episodes associated with heartburn were more frequently pure liquid (p = 0.009) and acidic (p = 0.027), had a lower nadir pH (p<0.001), were more frequently preceded by acid reflux episodes and had a longer reflux bolus clearance time. Conclusions: High proximal extent of the refluxate is the only factor associated with reflux perception in patients on double dose PPI. However, compared to regurgitation, composition of the refluxate, sensitisation of the oesophagus by preceding acid exposure, and delayed bolus clearance appear to play a role in heartburn perception.

            • gastro-oesophageal reflux
            • impedance
            • non-acid reflux
            • oesophageal pH
            • proton pump inhibitors

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