An analysis of persistent symptoms in acid-suppressed patients undergoing impedance-pH monitoring.
OBJECTIVE
Despite proton-pump inhibitors (PPIs), patients may have persistent symptoms of gastroesophageal reflux disease (GERD). We aimed to identify symptom types and frequency experienced by patients on PPI therapy, and to identify the type of reflux, if any, associated with these symptoms.


METHODS
A retrospective review was performed of 200 patients on PPI with GERD symptoms during ambulatory impedance-pH testing. The symptom index (SI) was determined for each symptom, and an SI of 50% or more was considered positive. Patients were divided into 2 groups: those with exclusively nonacid reflux (NAR) episodes and those with mixed-acid and NAR episodes. Symptom profiles were compared between these 2 groups.


RESULTS
A total of 415 symptoms were reported by the 200 patients on twice-daily PPIs. Throat clearing was most common (24%). A total of 110 (27%) were typical symptoms and 305 (73%) were atypical. Typical symptoms were more likely to have a positive SI than atypical symptoms (48% vs 25%, P < .01). Eighty-four patients (42%) had a positive SI, and 116 patients (58%) had a negative SI. One hundred patients (50%) had only NAR; the other 100 had mixed acid and NAR. Heartburn (21% vs 63%, P < .01) and nausea (8% vs 44%, P < .01) were more likely associated with reflux in the mixed-acid and NAR group.


CONCLUSIONS
Patients on PPIs still experience GERD symptoms. Impedance-pH monitoring identifies similar symptom associations with all types of reflux and also clarifies symptoms not related to any reflux.
Sharma
Neeraj
N
Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA. sharman@musc.edu
Agrawal
Amit
A
Freeman
Janice
J
Vela
Marcelo F
MF
Castell
Donald
D
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004502:Education, Medical, Continuing; D017097:Electric Impedance; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology*; D005773:Gastroscopy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000379:methods; D008991:Monitoring, Physiologic / Q000379:methods*; D011336:Probability; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D018434:Sickness Impact Profile
D054328:Proton Pump Inhibitors