title: Relationship between symptom response and esophageal pH level on standard dose of esomeprazole treatment for gastroesophageal reflux disease.
abstract: BACKGROUND
  The relationship between symptom elimination and normalization of esophageal acid level of gastroesophageal reflux disease (GERD) on proton-pump inhibitor (PPI) therapy has been questioned. This study aimed to evaluate the relationship between symptom response and gastro-esophageal acidity control in Chinese patients with GERD on esomeprazole therapy, and to assess the role of 24-hour esophageal pH-metry after therapy in GERD patients.
  
  
  METHODS
  GERD patients with typical reflux symptoms were enrolled and received esomeprazole 40 mg once daily for 4 weeks. Patients with positive baseline 24-hour esophageal pH-metry were divided into two groups depending on an additional dual-channel 24-hour pH-metry after treatment. The pH- group achieved normalization of esophageal pH level whereas the pH+ group did not.
  
  
  RESULTS
  Of the 80 patients studied, 76 had abnormal baseline esophageal pH levels. Of these, 90% (52/58) of symptom-free patients and 67% (12/18) of symptom-persistent patients achieved esophageal pH normalization after therapy (P = 0.030). The mean post-therapy gastric nocturnal percent time of pH < 4.0 was significantly higher in pH+ group than that in pH- group (P < 0.001) after therapy. The multivariate regression analysis identified hiatus hernia (P < 0.001) and persistent reflux symptom (P = 0.004) were two independent factors predicting the low post-therapy esophageal pH level.
  
  
  CONCLUSIONS
  Symptom elimination is not always accompanied by esophageal pH normalization, and vice verse. Esophageal pH-metry is recommended for GERD patients with hiatus hernia or with persistent reflux symptoms after PPI therapy.
authors.affiliation: Division of Gastroenterology & Hepatology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
authors.forename: Sui
authors.initials: S
authors.lastname: Peng
authors.forename: Li-shou
authors.initials: LS
authors.lastname: Xiong
authors.forename: Ying-lian
authors.initials: YL
authors.lastname: Xiao
authors.forename: An-jiang
authors.initials: AJ
authors.lastname: Wang
authors.forename: Jin-kun
authors.initials: JK
authors.lastname: Lin
authors.forename: Pin-jin
authors.initials: PJ
authors.lastname: Hu
authors.forename: Min-hu
authors.initials: MH
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D016099:Endoscopy, Gastrointestinal; D064098:Esomeprazole / Q000627:therapeutic use*; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000378:metabolism / Q000473:pathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000897:Anti-Ulcer Agents; D064098:Esomeprazole