The role of gastroesophageal reflux in relation to symptom onset in patients with proton pump inhibitor-refractory nonerosive reflux disease accompanied by an underlying esophageal motor disorder.
BACKGROUND
The symptom improvement rate is low with proton pump inhibitors (PPIs) in nonerosive reflux disease (NERD). The underlying pathogenic mechanism is complex. Esophageal motility disorders (EMDs) are thought to be a factor, but their prevalence, type, symptoms and the role played by gastroesophageal reflux (GER) in symptom onset have not been fully investigated.


OBJECTIVE
To investigate the role of GER in symptom onset in PPI-refractory NERD patients with EMDs.


METHODS
This study comprised 76 patients with PPI-refractory NERD. Manometry was performed during PPI treatment and patients were divided into an EMD group and normal motility (non-EMD) group. Then, multichannel intraluminal impedance-pH monitoring was performed and medical interviews were conducted.


RESULTS
Nineteen patients (25%) had an EMD. Data were compared between 17 patients, excluding 2 with achalasia and 57 non-EMD patients. No significant differences were observed between groups in 24-hour intraesophageal pH <4 holding time (HT), mean number of GER episodes or mean number of proximal reflux episodes. The reflux-related symptom index (≥50%) showed a relationship between reflux and symptoms in 70.5% of EMD patients and 75% of non-EMD patients. In the EMD group, the score for FSSG (Frequency Scale for the Symptoms of GERD) question (Q)10 was significantly correlated with the number of GER episodes (r = 0.58, p = 0.02) and the number of proximal reflux episodes (r = 0.63, p = 0.02). In addition, the score for Q9 tended to be correlated with the number of GER episodes (r = 0.44, p = 0.06).


CONCLUSIONS
Our results suggest that some PPI-refractory NERD patients have EMDs, and that GER plays a role in symptom onset.
Department of Internal Medicine, Division of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan.
Shinya
S
Izawa
Yasushi
Y
Funaki
Akihito
A
Iida
Kentaro
K
Tokudome
Yasuhiro
Y
Tamura
Naotaka
N
Ogasawara
Makoto
M
Sasaki
Kunio
K
Kasugai
D015154:Esophageal Motility Disorders / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000209:etiology*; D006356:Heartburn / Q000209:etiology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D017211:Treatment Failure
D054328:Proton Pump Inhibitors