title: Increased frequency and enhanced perception of reflux in non-erosive reflux disease patients non-responders to proton pump inhibitors.
abstract: BACKGROUND
  The unsatisfactory response to medical treatment in non-erosive patients is becoming a real challenge for gastroenterologists. Non-responder patients, evaluated under treatment, present symptoms which are related to non-acidic, mixed and proximal reflux episodes.
  
  
  METHODS
  To elucidate the reflux pattern and mechanisms related to persistence of symptoms despite treatment, oesophageal pH-impedance was performed in 55 non-erosive responder and 24 non-responder patients, studied off therapy. Ten responder and 10 non-responder patients underwent a repeated study during proton pump inhibitor treatment.
  
  
  RESULTS
  Non-responders were characterised by a higher overall number and larger proportion of symptomatic reflux episodes. Non-responders were also characterised by an enhanced sensitivity to acidic, mixed and proximal refluxes. Weakly acidic reflux accounted for 29% of symptomatic refluxes in non-responders and 34% in responders. Proportions of acidic and weakly acidic reflux episodes were comparable both in responders and non-responders when analysed off and on treatment.
  
  
  CONCLUSIONS
  An increased overall number of reflux episodes and enhanced sensitivity to reflux are strongly associated with treatment failure. Treatment strategies aimed at decreasing transient lower oesophageal sphincter relaxations, pain modulators or anti-reflux surgery should be considered in non-responders in whom a significant relationship between symptoms and reflux has been confirmed.
authors.affiliation: Department of Digestive Disease, University Campus Bio Medico, Rome, Italy.
authors.forename: Mentore
authors.initials: M
authors.lastname: Ribolsi
authors.forename: Sara
authors.initials: S
authors.lastname: Emerenziani
authors.forename: Tommasangelo
authors.initials: T
authors.lastname: Petitti
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Addarii
authors.forename: Paola
authors.initials: P
authors.lastname: Balestrieri
authors.forename: Michele
authors.initials: M
authors.lastname: Cicala
mesh_terms: D000328:Adult; D000368:Aged; D050782:Esophageal pH Monitoring; D005260:Female; D005750:Gastric Juice / Q000737:chemistry; D006356:Heartburn / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D057045:Laryngopharyngeal Reflux / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010465:Perception; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D018709:Statistics, Nonparametric; D013997:Time Factors; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors