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Usefulness of baseline impedance in patients with proton pump inhibitor‐refractory nonerosive reflux disease
Author(s) -
Kohata Yukie,
Fujiwara Yasuhiro,
Yamagami Hirokazu,
Tanigawa Tetsuya,
Shiba Masatsugu,
Watanabe Kenji,
Watanabe Toshio,
Tominaga Kazunari,
Arakawa Tetsuo
Publication year - 2015
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12743
Subject(s) - nerd , reflux , heartburn , medicine , proton pump inhibitor , gastroenterology , gerd , refractory (planetary science) , esophageal ph monitoring , reflux esophagitis , disease , physics , astrobiology
Background and Aim Approximately more than half of patients with non‐erosive reflux disease ( NERD ) do not respond to proton pump inhibitor ( PPI ) therapy. Although NERD is a heterogeneous entity, previous study showed that multichannel intraluminal impedance ( MII )‐p H monitoring could distinguish reflux‐related disease from PPI ‐refractory NERD . The aim of this study was to examine the usefulness of baseline impedance in PPI ‐refractory NERD patients. Methods We used MII ‐p H monitoring to analyze reflux parameters, symptom index ( SI ), and baseline impedance in 37 PPI ‐refractory NERD patients on PPI . Reflux was divided into acid (nadir p H ≤ 4) and non‐acid (nadir p H > 4). Subjects were classified as having reflux‐related disease based on abnormal reflux parameters or positive SI (≥ 50%), or non‐reflux‐related disease, including functional heartburn, based on negative SI with normal reflux parameters. Results A total of 26 of the 37 subjects were diagnosed with reflux‐related disease, including eight with acid‐reflux type and 18 with non‐acid‐reflux type, and nine with functional heartburn and two with pseudohypersalivation. There were no significant differences in the clinical characteristics of the acid‐reflux type, non‐acid‐reflux type, and functional heartburn groups. The baseline impedance value in the acid‐reflux type (1245 ± 392 Ω) was significantly lower than that in the non‐acid‐reflux type (2824 ± 1160 Ω) and functional heartburn (3546 ± 1353 Ω) groups. Baseline impedance values inversely correlated with reflux percent time, acid‐reflux time, and acid exposure time. Conclusion Among patients with PPI ‐refractory NERD , acid‐reflux type was associated with lower baseline impedance compared with non‐acid‐reflux type and functional heartburn.