title: Comparison of the degree of duodenogastroesophageal reflux and acid reflux between patients who failed to respond and those who were successfully treated with a proton pump inhibitor once daily.
abstract: OBJECTIVE
  The objective of this study was to compare the degree of esophageal acid exposure and duodenogastroesophageal reflux (DGER) during treatment between gastroesophageal reflux disease (GERD) patients who responded fully to proton pump inhibitor (PPI) once a day and those who failed to respond.
  
  
  METHODS
  Gastroesophageal reflux disease patients who continued to report symptoms 3 times a week for 3 months while on PPI once a day were assigned to the PPI failure group. GERD patients who were asymptomatic on PPI once a day for 3 months were assigned to the PPI success group. All patients underwent upper endoscopy to assess esophageal mucosal injury. Subsequently, all patients underwent simultaneous 24-h esophageal Bilitec 2000 and pH testing while on treatment. Patients recorded GERD-related symptoms during the test.
  
  
  RESULTS
  Twenty-four patients were enrolled in the PPI failure group and 23 patients were enrolled in the PPI success group. Endoscopy was normal in 63% of PPI failure patients and 76% of PPI success patients. Abnormal DGER was documented in 82% of PPI success patients vs. 67% of PPI failure patients (P=NS). All pH testing and Bilitec parameters in the PPI failure group were similar to those in the PPI success group (P=NS). Of the 34 GERD symptoms recorded by the PPI failure group, 64% were associated with acid reflux and 41% were associated with DGER (P<0.05).
  
  
  CONCLUSIONS
  There is no difference in the degree of DGER and acid exposure during treatment between patients who failed to respond and those who achieved complete symptom resolution on PPI once daily. GERD symptoms in the PPI failure group are more commonly associated with acid reflux than with DGER.
authors.affiliation: Department of Medicine, Neuroenteric Clinical Research Group, Southern Arizona VA Health Care System and University of Arizona Health Sciences Center, Tucson, Arizona 85723-0001, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Gasiorowska
authors.forename: Tomas
authors.initials: T
authors.lastname: Navarro-Rodriguez
authors.forename: Christopher
authors.initials: C
authors.lastname: Wendel
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Krupinski
authors.forename: Zvi H
authors.initials: ZH
authors.lastname: Perry
authors.forename: Kristina
authors.initials: K
authors.lastname: Koenig
authors.forename: Bridget
authors.initials: B
authors.lastname: Moty
authors.forename: Jeannette
authors.initials: J
authors.lastname: Powers
authors.forename: Ronnie
authors.initials: R
authors.lastname: Fass
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004334:Drug Administration Schedule; D004383:Duodenogastric Reflux / Q000188:drug therapy* / Q000503:physiopathology; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage*; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D012074:Remission Induction; D017211:Treatment Failure
chemical_list: D054328:Proton Pump Inhibitors; D009853:Omeprazole