title: Tailored therapy for the refractory GERD patients by combined multichannel intraluminal impedance-pH monitoring.
abstract: OBJECTIVE
  About 30% of patients with gastroesophageal reflux disease (GERD) are refractory to proton pump inhibitor (PPI). The reason for the PPI failure in Asian GERD patients has rarely been studied, and the therapy remained unclear. The aims were to explore the possible reasons for PPI failure and to treat these patients with the guidance of 24-h multichannel intraluminal impedance-pH (MII-pH) monitoring.
  
  
  METHODS
  Thirty-nine consecutive patients with refractory GERD were enrolled; 24-h MII-pH monitoring was performed on PPI. The refractory GERD patients were grouped into acid overexposure, non-acid reflux, and functional heartburn after the MII-pH monitoring. Double dose of either PPI or paroxetine was administered to refractory GERD patients within different groups.
  
  
  RESULTS
  The number of patients in groups of acid overexposure, non-acid reflux, and functional heartburn was 6, 12, and 21, respectively. The acid overexposure group had the most acid reflux events. Among the acid overexposure group, five (5/6) patients accomplish symptom relief with double dose of esomeprazole. For the patients in non-acid reflux group, double dose of esomeprazole made half (6/12) of the patients obtain symptom relief. For the patients in functional heartburn group, the paroxetine had relieved the symptoms in 14 patients among all the 21 patients. In total, with the guidance of MII-pH monitoring, 64.1% (25/39) of refractory GERD patients accomplished symptom relief.
  
  
  CONCLUSIONS
  Acid overexposure, non-acid reflux, and functional heartburn were the common reasons for persistent reflux symptoms despite PPI. With the guidance of MII-pH, a tailored therapy could resolve the persistent reflux symptoms among two-third of patients.
authors.affiliation: Department of Gastroenterology and Hepatolgy.
authors.forename: Yinglian
authors.initials: Y
authors.lastname: Xiao
authors.affiliation: Department of Cardiac Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Mengya
authors.initials: M
authors.lastname: Liang
authors.affiliation: Department of Gastroenterology and Hepatolgy.
authors.forename: Sui
authors.initials: S
authors.lastname: Peng
authors.affiliation: Department of Gastroenterology and Hepatolgy.
authors.forename: Ning
authors.initials: N
authors.lastname: Zhang
authors.affiliation: Department of Gastroenterology and Hepatolgy.
authors.forename: Minhu
authors.initials: M
authors.lastname: Chen
mesh_terms: D000328:Adult; D050782:Esophageal pH Monitoring / Q000379:methods*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017374:Paroxetine / Q000008:administration & dosage*; D057285:Precision Medicine / Q000379:methods*; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D017374:Paroxetine; D054328:Proton Pump Inhibitors; D017367:Selective Serotonin Reuptake Inhibitors
keywords: acid overexposure; functional heartburn; gastroesophageal reflux disease; multichannel intraluminal impedance-pH monitoring; non-acid reflux; proton pump inhibitor