title: Role of Acid and weakly acidic reflux in gastroesophageal reflux disease off proton pump inhibitor therapy.
abstract: OBJECTIVE
  Available data about reflux patterns and symptom determinants in the gastroesophageal reflux disease (GERD) subtypes off proton pump inhibitor (PPI) therapy are lacking. We aimed to evaluate reflux patterns and determinants of symptom perception in patients with GERD off PPI therapy by impedance-pH monitoring.
  
  
  METHODS
  We retrospectively reviewed the impedance-pH data in patients diagnosed as GERD based on results of impedance-pH monitoring, endoscopy and/or typical symptoms. The characteristics of acid and weakly acidic reflux were evaluated. Symptomatic and asymptomatic reflux were compared according to GERD subtypes and individual symptoms.
  
  
  RESULTS
  Forty-two patients (22 males, mean age 46 years) were diagnosed as GERD (17 erosive reflux disease, 9 pH(+) non-erosive reflux disease [NERD], 9 hypersensitive esophagus and 7 symptomatic NERD). A total of 1,725 reflux episodes were detected (855 acid [50%], 857 weakly acidic [50%] and 13 weakly alkaline reflux [< 1%]). Acid reflux was more frequently symptomatic and bolus clearance was longer compared with weakly acidic reflux. In terms of globus, weakly acidic reflux was more symptomatic. Symptomatic reflux was more frequently acid and mixed reflux; these associations were more pronounced in erosive reflux disease and symptomatic NERD. The perception of regurgitation was related to acid reflux, while that of globus was more related to weakly acidic reflux.
  
  
  CONCLUSIONS
  In patients not taking PPI, acid reflux was more frequently symptomatic and had longer bolus clearance. Symptomatic reflux was more frequently acid and mixed type; however, weakly acidic reflux was associated more with globus. These data suggest a role for impedance-pH data in the evaluation of globus.
authors: Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea.
authors: Hea Jung
authors: HJ
authors: Sung
authors: Yu Kyung
authors: YK
authors: Cho
authors: Sung Jin
authors: SJ
authors: Moon
authors: Jin Su
authors: JS
authors: Kim
authors: Chul Hyun
authors: CH
authors: Lim
authors: Jae Myung
authors: JM
authors: Park
authors: In Seok
authors: IS
authors: Lee
authors: Sang Woo
authors: SW
authors: Kim
authors: Myung-Gye
authors: MG
authors: Choi