title: Prospective evaluation of duodenogastroesophageal reflux in gastroesophageal reflux disease patients refractory to proton pump inhibitor therapy.
abstract: BACKGROUND
  Duodenogastroesophageal reflux (DGER) is considered an independent risk factor for complicated reflux disease (gastroesophageal reflux disease; GERD). However, the role of DGER in GERD patients refractory to proton pump inhibitors (PPI) remains poorly understood.
  
  
  METHODS
  85 patients with clinical reflux symptoms and a history of ineffective response to PPIs were enrolled in the study. Patients with elevated reflux measurement (pH and/or Bilitec measurement; n = 47) received pantoprazole 80 mg for 8 weeks. Clinical outcome was defined as response (≤2 symptoms/week) or nonresponse (≥3 symptoms/week).
  
  
  RESULTS
  Of the 47 patients with elevated reflux measurement, 30 were classified as responders and 17 as nonresponders. Treatment with pantoprazole resulted in a significant reduction of acidic reflux in both PPI responders and PPI nonresponders. In contrast, DGER was only significantly reduced in the PPI responder group (22.8 ± 22.8 vs. 6.6 ± 10.8%; p < 0.05) but not in the PPI nonresponder group (24.5 ± 18.6 vs. 22.2 ± 12.7%; p > 0.05).
  
  
  CONCLUSIONS
  The presented study firstly describes that nonresponsiveness to PPI is associated with a limited effect of PPIs on reducing DGER. Thus, persistent DGER may play a key role in mediating reflux symptoms refractory to high-dose PPIs.
authors.affiliation: Department of Gastroenterology, Endocrinology and Metabolism, Faculty of Medicine, Philipps University of Marburg, Marburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Kunsch
authors.forename: A
authors.initials: A
authors.lastname: Neesse
authors.forename: T
authors.initials: T
authors.lastname: Linhart
authors.forename: C
authors.initials: C
authors.lastname: Nell
authors.forename: T M
authors.initials: TM
authors.lastname: Gress
authors.forename: V
authors.initials: V
authors.lastname: Ellenrieder
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use*; D000328:Adult; D001655:Bile Reflux / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D004351:Drug Resistance; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology; D050782:Esophageal pH Monitoring; D004945:Esophagoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D000077402:Pantoprazole; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D018709:Statistics, Nonparametric
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D054328:Proton Pump Inhibitors; D000077402:Pantoprazole