title: Esophageal motor dysfunction plays a key role in GERD with globus sensation--analysis of factors promoting resistance to PPI therapy.
abstract: OBJECTIVE
  Patients with gastroesophageal reflux disease (GERD) also have various extra-esophageal symptoms. Laryngopharyngeal reflux disease (LPRD) is a subtype of GERD associated with globus sensation, but proton pump inhibitor (PPI) therapy achieves disappointing results. This study investigated esophageal motility in GERD patients with globus sensation who were resistant to PPI therapy.
  
  
  METHODS
  The subjects were 350 patients with globus sensation. All patients underwent both laryngoscopy and upper gastrointestinal endoscopy to exclude organic disease. After 4 weeks of treatment with rabeprazole sodium (20 mg daily), the patients were divided into PPI-responsive and PPI-resistant groups. Then we investigated esophageal motility in the PPI-resistant group by a multichannel intraluminal impedance and manometry study.
  
  
  RESULTS
  A total of 119 patients (55.6%) were resistant to PPI therapy, among whom 57 patients (47.9%) had abnormal esophageal motility. They included 36 patients (66.4%) with ineffective esophageal motility, 9 patients (14.4%) with achalasia, 6 patients (9.6%) with diffuse esophageal spasm, 5 patients (8%) with nutcracker esophagus, and 1 patient (1.6%) with hypertensive lower esophageal sphincter. There were significant differences of upper esophageal sphincter pressure and esophageal body peristalsis between the patients with PPI-resistant LPRD and healthy controls matched for age and sex.
  
  
  CONCLUSIONS
  Among patients with PPI-resistant LPRD, 47.9% had abnormal esophageal motility.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, Kawasaki Medical School, Kurashiki, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Tsutsui
authors.forename: Noriaki
authors.initials: N
authors.lastname: Manabe
authors.forename: Masako
authors.initials: M
authors.lastname: Uno
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
authors.forename: Tomoari
authors.initials: T
authors.lastname: Kamada
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kusunoki
authors.forename: Akiko
authors.initials: A
authors.lastname: Shiotani
authors.forename: Jiro
authors.initials: J
authors.lastname: Hata
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Harada
authors.forename: Ken
authors.initials: K
authors.lastname: Haruma
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D004351:Drug Resistance; D017097:Electric Impedance; D015154:Esophageal Motility Disorders / Q000503:physiopathology; D049631:Esophageal Sphincter, Upper / Q000503:physiopathology; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D006801:Humans; D057045:Laryngopharyngeal Reflux / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010528:Peristalsis; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D064750:Rabeprazole; D012677:Sensation; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D054328:Proton Pump Inhibitors; D064750:Rabeprazole