title: Combined pH-impedance monitoring and high-resolution manometry of Japanese patients treated with proton-pump inhibitors for persistent symptoms of non-erosive reflux disease.
abstract: BACKGROUND
  Data on acid and non-acid reflux patterns and esophageal function in Japanese patients with non-erosive reflux disease (NERD) are limited. The aim of this study was to use combined multichannel intraluminal impedance pH monitoring (MII-pH) and high-resolution manometry (HRM) to investigate the characteristics of Japanese patients who were treated with a "double-dose" (20 mg) of rabeprazol (a proton-pump inhibitor; PPI) for persistent symptoms of NERD.
  
  
  METHODS
  Twenty-five patients who complained of typical gastroesophageal reflux disease symptoms, which had occurred more than twice a week despite treatment with rabeprazol, were enrolled in the study. All patients underwent upper endoscopy, esophageal HRM, and 24-h MII-pH monitoring while double-dose PPI therapy was continued.
  
  
  RESULTS
  Twelve (48.0%) of the patients had a positive symptom index (SI) with 234 recorded symptoms, 127 (54.3%) of which were related to reflux episodes. Of those with reflux episodes, 29 (22.8%) were related to acid reflux, while 98 (77.2%) were the result of a weaker acidic reflux. In acid reflux and in mixed (liquid-gas) reflux, the proximal esophageal region was involved to a significantly greater degree (P<0.002 and P=0.005, respectively) than the distal region. In liquid reflux, there was no difference between the distal and proximal regions. HRM showed that proximal motility parameters were significantly more defective than in those of healthy volunteers.
  
  
  CONCLUSIONS
  MII-pH monitoring indicated that weakly acidic reflux and mixed refluxate in the proximal esophagus is the major cause of persistent symptoms in patients with NERD who are being treated with PPI. HRM showed that proximal esophageal dysfunction might be a key condition that facilitates reflux.
authors.affiliation: Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, Japan. onakaryoko0310@gmail.com
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamashita
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ashida
authors.forename: Takumi
authors.initials: T
authors.lastname: Fukuchi
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Nagatani
authors.forename: Hideaki
authors.initials: H
authors.lastname: Koga
authors.forename: Kasane
authors.initials: K
authors.lastname: Senda
authors.forename: Takaaki
authors.initials: T
authors.lastname: Eguchi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ubukata
authors.forename: Shinpei
authors.initials: S
authors.lastname: Kawaguchi
authors.forename: Aya
authors.initials: A
authors.lastname: Ueda
authors.forename: Toshio
authors.initials: T
authors.lastname: Tanaka
authors.forename: Rina
authors.initials: R
authors.lastname: Ohashi
authors.forename: Dai
authors.initials: D
authors.lastname: Ito
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D004945:Esophagoscopy / Q000379:methods; D004947:Esophagus / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007564:Japan; D008297:Male; D008365:Manometry; D008875:Middle Aged; D008991:Monitoring, Physiologic; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D064750:Rabeprazole
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D054328:Proton Pump Inhibitors; D064750:Rabeprazole