title: Evaluation of proton pump inhibitor-resistant nonerosive reflux disease by esophageal manometry and 24-hour esophageal impedance and pH monitoring.
abstract: BACKGROUND
  Patients with proton pump inhibitor (PPI)-resistant nonerosive reflux disease (NERD) include subgroups that have markedly different pathophysiology. This study aimed to clarify the pathophysiology of NERD by esophageal manometry with 24-hour esophageal impedance and pH monitoring.
  
  
  METHODS
  Eighteen consecutive outpatients referred to our expert center for functional gastrointestinal motility with suspected PPI-resistant NERD were enrolled. Manometry was performed to detect esophageal motility disorders. Subsequently, 24-hour esophageal impedance and pH monitoring was done while patients were on PPI therapy.
  
  
  RESULTS
  Manometry revealed 1 case of achalasia, 1 case of nutcracker esophagus and 3 cases of diffuse esophageal spasm. Three patients had ineffective esophageal motility, with impedance and pH monitoring being performed in 2 of them. Esophageal acid exposure (%time pH <4) was normal in both, but the symptom index (SI) was positive for nonacidic reflux in 1 patient. One of the 10 patients with normal esophageal motility had abnormal esophageal acid exposure. The SI was positive for weakly acidic and nonacidic reflux in 3 of the remaining 9 patients with normal esophageal acid exposure. Five of the other 6 patients seemed to have functional heartburn.
  
  
  CONCLUSIONS
  A substantial percentage (28%) of patients with suspected PPI-resistant NERD had primary esophageal motility disorders. Both nonacidic reflux and weakly acidic reflux are important contributors to the symptoms of patients with PPI-resistant NERD. Esophageal manometry is required to exclude motility disorders, while 24-hour esophageal impedance and pH monitoring is invaluable for assessing symptom-reflux associations and the indications for fundoplication in patients with suspected PPI-resistant NERD.
authors: Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, Maebashi, Japan.
authors: Osamu
authors: O
authors: Kawamura
authors: Hiroko
authors: H
authors: Hosaka
authors: Yasuyuki
authors: Y
authors: Shimoyama
authors: Akiyo
authors: A
authors: Kawada
authors: Shiko
authors: S
authors: Kuribayashi
authors: Motoyasu
authors: M
authors: Kusano
authors: Masanobu
authors: M
authors: Yamada
mesh_terms: D000328:Adult; D000368:Aged; D003938:Diagnostic Techniques, Digestive System; D004351:Drug Resistance; D017097:Electric Impedance; D004568:Electrodiagnosis / Q000379:methods*; D015154:Esophageal Motility Disorders / Q000175:diagnosis* / Q000601:surgery; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000503:physiopathology; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use
chemical_list: D054328:Proton Pump Inhibitors