title: Determinants of gastro-oesophageal reflux perception in patients with persistent symptoms despite proton pump inhibitors.
abstract: OBJECTIVE
  Approximately 20% of patients have persistent symptoms of gastro-oesophageal reflux despite proton pump inhibitor (PPI) therapy. The aim of this study was to assess the determinants of reflux perception in patients on PPI therapy.
  
  
  METHODS
  20 patients with typical gastro-oesophageal reflux symptoms (heartburn and/or regurgitation) despite double-dose PPIs (twice daily) were included in this study. Ambulatory 24 h 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 with 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 (p<0.001) and had a longer reflux bolus clearance time (p<0.001).
  
  
  CONCLUSIONS
  High proximal extent of the refluxate is the only factor associated with reflux perception in patients on double-dose PPI. However, compared with 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.
authors.affiliation: CHU Bordeaux, Saint André Hospital, Gastroenterology Department, Bordeaux, France. frank.zerbib@chu-bordeaux.fr
authors.forename: F
authors.initials: F
authors.lastname: Zerbib
authors.forename: A
authors.initials: A
authors.lastname: Duriez
authors.forename: S
authors.initials: S
authors.lastname: Roman
authors.forename: M
authors.initials: M
authors.lastname: Capdepont
authors.forename: F
authors.initials: F
authors.lastname: Mion
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000502:physiology*; D005260:Female; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000378:metabolism; D006356:Heartburn / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*
chemical_list: D054328:Proton Pump Inhibitors