Original articleAlimentary tractIncreased Proximal Reflux in a Hypersensitive Esophagus Might Explain Symptoms Resistant to Proton Pump Inhibitors in Patients With Gastroesophageal Reflux Disease
Section snippets
Patients
We included 18 patients with GERD, of whom 9 patients were PPI responders (5 men; age, 59 y), and 9 patients experienced refractory symptoms on PPI (2 men; age, 52 y). The latter category of patients was classified as partial PPI responders. A diagnosis of GERD was based on the observation of esophagitis during endoscopy and/or a pathologic acid exposure, both in combination with typical reflux symptoms off PPI. In GERD patients with complete response, typical reflux symptoms were absent during
Patients
In all 18 patients esophageal sensitivity measurements and the postprandial reflux protocol were completed. In 2 patients (1 responder, 1 partial responder) endoscopy could not be performed, such that no biopsy specimens were available for Ussing experiments.
No significant differences were found in ages or sex between complete and partial responders (age, 59 ± 4.9 vs 52 ± 6.4 y, P = .39; sex, 5 males vs 2 males, P = .34). The PPIs used were omeprazole, pantoprazole, and esomeprazole (8, 5, and
Discussion
Visceral hypersensitivity, impaired mucosal integrity, and differences in acidity and position of the acid pocket have been hypothesized to contribute to PPI-resistant symptoms in GERD patients. In the current study we showed that mucosal permeability and the position of the acid pocket are similar in PPI partial responders and responders and are therefore less likely to explain persistent symptoms. In contrast, esophageal sensitivity to distension and the number of reflux episodes with a
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Cited by (27)
Most Patients With Gastroesophageal Reflux Disease Who Failed Proton Pump Inhibitor Therapy Also Have Functional Esophageal Disorders
2019, Clinical Gastroenterology and HepatologyCitation Excerpt :Although our cohort size was small, our results are supported by another study13 demonstrating no difference in the degree of esophageal reflux exposure between patients who failed to respond and those who achieved symptom resolution while taking once-daily PPI. Furthermore, a study conducted by Rohof et al25 showed that partial responders to PPI are most likely explained by increased proximal reflux in a hypersensitive esophagus, as opposed to number of reflux events, increased mucosal permeability, or the position of the acid pocket. In summary, our study is the first to demonstrate that reflux characteristics, using impedance pH, were not significantly different between patients who responded to those who failed PPI once daily.
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Conflicts of interest The authors disclose no conflicts.