title: Categorization of patients with reflux symptoms referred for pH and impedance testing while off therapy.
abstract: OBJECTIVE
  Patients with suspected gastroesophageal reflux disease (GERD) often are treated empirically with proton pump inhibitors (PPIs). Patients whose symptoms are not reduced during the PPI trial are referred for further tests. We investigated whether patients referred for the evaluation of reflux symptoms had GERD. We also aimed to categorize patients with a poor response to PPIs into groups with hypersensitive esophagus or functional heartburn.
  
  
  METHODS
  We performed a retrospective study, searching a clinical database of patients referred for GERD testing from 2006 through 2011. We collected data on all patients who underwent upper endoscopy, esophageal manometry, and 24-hour pH-impedance monitoring, and were off PPIs for at least 1 week. Evidence of GERD was determined by an abnormal upper endoscopy or 24-hour pH-impedance monitoring. Further categorization was determined by impedance results and the symptom association probability index.
  
  
  RESULTS
  We identified 221 patients (mean age, 47.6 ± 13.3 y; 56% male; 61% Caucasians); 97% previously had been prescribed PPIs, before they were tested. The patients had erosive esophagitis (n = 21; 10%), nonerosive reflux disease with increased pH (n = 61; 27%), nonerosive reflux disease with abnormal impedance (n = 18; 8%), hypersensitive esophagus (n = 30; 14%), functional heartburn (n = 18; 8%), functional disorders other than heartburn (n = 30; 14%), and undetermined disorders (n = 43; 19%).
  
  
  CONCLUSIONS
  In a retrospective analysis of 221 patients, roughly half of the patients referred for testing did not have evidence of GERD. Further categorization of patients can help guide diagnosis and management.
authors.affiliation: Department of Medicine, Gastroenterology Service, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Fong-Kuei F
authors.initials: FK
authors.lastname: Cheng
authors.affiliation: Department of Medicine, Gastroenterology Service, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Dustin M
authors.initials: DM
authors.lastname: Albert
authors.affiliation: Department of Medicine, Gastroenterology Service, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Corinne L
authors.initials: CL
authors.lastname: Maydonovitch
authors.affiliation: Department of Medicine, Gastroenterology Service, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Roy K
authors.initials: RK
authors.lastname: Wong
authors.affiliation: Department of Medicine, Gastroenterology Service, Walter Reed National Military Medical Center, Bethesda, Maryland. Electronic address: fouad.j.moawad.mil@mail.mil.
authors.forename: Fouad J
authors.initials: FJ
authors.lastname: Moawad
mesh_terms: D000328:Adult; D017097:Electric Impedance; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000473:pathology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D054328:Proton Pump Inhibitors
keywords: Functional Heartburn; Hypersensitive Esophagus; Nonerosive Reflux Disease