title: Characteristics of symptomatic reflux episodes in Japanese proton pump inhibitor-refractory non-erosive reflux disease patients.
abstract: OBJECTIVE
  To clarify the pathogenesis of gastroesophageal reflux disease symptoms in non-erosive reflux disease (NERD) patients.
  
  
  METHODS
  Thirty-five NERD patients with persistent symptoms, despite taking rabeprazole 10 mg twice daily for at least 8 wk, were included in this study. All patients underwent 24 h combined impedance - pH on rabeprazole. The symptom index (SI) was considered to be positive if ≥ 50%, and proximal reflux episodes were determined when reflux reached 15 cm above the proximal margin of the lower esophageal sphincter.
  
  
  RESULTS
  In 14 (40%) SI-positive patients, with liquid weakly acid reflux, the occurrence rate of reflux symptoms was significantly more frequent in proximal reflux episodes (46.7%) than in distal ones (5.7%) (P < 0.001). With liquid acid reflux, there were no significant differences in the occurrence rate of reflux symptoms between proximal reflux episodes (38.5%) and distal ones (20.5%) (NS). With mixed liquid-gas weakly acid reflux, the occurrence rate of reflux symptoms in proximal reflux episodes was significantly more frequent (31.0%) than in distal reflux ones (3.3%) (P < 0.001). With mixed liquid-gas acid reflux, there were no significant differences in the occurrence rate of reflux symptoms between proximal reflux episodes (29.4%) and distal ones (14.3%) (NS).
  
  
  CONCLUSIONS
  The proximal extent of weakly acidic liquid and mixed liquid-gas reflux is a major factor associated with reflux perception in SI-positive patients on proton pump inhibitor therapy.
authors.affiliation: Kenichiro Nakagawa, Tomoyuki Koike, Katsunori Iijima, Masahiro Saito, Hiroki Kikuchi, Waku Hatta, Nobuyuki Ara, Kaname Uno, Naoki Asano, Tooru Shimosegawa, Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai Miyagi 980-8574, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Nakagawa
authors.affiliation: Kenichiro Nakagawa, Tomoyuki Koike, Katsunori Iijima, Masahiro Saito, Hiroki Kikuchi, Waku Hatta, Nobuyuki Ara, Kaname Uno, Naoki Asano, Tooru Shimosegawa, Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai Miyagi 980-8574, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Koike
authors.affiliation: Kenichiro Nakagawa, Tomoyuki Koike, Katsunori Iijima, Masahiro Saito, Hiroki Kikuchi, Waku Hatta, Nobuyuki Ara, Kaname Uno, Naoki Asano, Tooru Shimosegawa, Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai Miyagi 980-8574, Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Iijima
authors.affiliation: Kenichiro Nakagawa, Tomoyuki Koike, Katsunori Iijima, Masahiro Saito, Hiroki Kikuchi, Waku Hatta, Nobuyuki Ara, Kaname Uno, Naoki Asano, Tooru Shimosegawa, Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai Miyagi 980-8574, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Saito
authors.affiliation: Kenichiro Nakagawa, Tomoyuki Koike, Katsunori Iijima, Masahiro Saito, Hiroki Kikuchi, Waku Hatta, Nobuyuki Ara, Kaname Uno, Naoki Asano, Tooru Shimosegawa, Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai Miyagi 980-8574, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kikuchi
authors.affiliation: Kenichiro Nakagawa, Tomoyuki Koike, Katsunori Iijima, Masahiro Saito, Hiroki Kikuchi, Waku Hatta, Nobuyuki Ara, Kaname Uno, Naoki Asano, Tooru Shimosegawa, Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai Miyagi 980-8574, Japan.
authors.forename: Waku
authors.initials: W
authors.lastname: Hatta
authors.affiliation: Kenichiro Nakagawa, Tomoyuki Koike, Katsunori Iijima, Masahiro Saito, Hiroki Kikuchi, Waku Hatta, Nobuyuki Ara, Kaname Uno, Naoki Asano, Tooru Shimosegawa, Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai Miyagi 980-8574, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ara
authors.affiliation: Kenichiro Nakagawa, Tomoyuki Koike, Katsunori Iijima, Masahiro Saito, Hiroki Kikuchi, Waku Hatta, Nobuyuki Ara, Kaname Uno, Naoki Asano, Tooru Shimosegawa, Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai Miyagi 980-8574, Japan.
authors.forename: Kaname
authors.initials: K
authors.lastname: Uno
authors.affiliation: Kenichiro Nakagawa, Tomoyuki Koike, Katsunori Iijima, Masahiro Saito, Hiroki Kikuchi, Waku Hatta, Nobuyuki Ara, Kaname Uno, Naoki Asano, Tooru Shimosegawa, Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai Miyagi 980-8574, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Asano
authors.affiliation: Kenichiro Nakagawa, Tomoyuki Koike, Katsunori Iijima, Masahiro Saito, Hiroki Kikuchi, Waku Hatta, Nobuyuki Ara, Kaname Uno, Naoki Asano, Tooru Shimosegawa, Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai Miyagi 980-8574, Japan.
authors.forename: Tooru
authors.initials: T
authors.lastname: Shimosegawa
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D004334:Drug Administration Schedule; D004351:Drug Resistance; D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology; D006356:Heartburn / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010465:Perception; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D064750:Rabeprazole / Q000008:administration & dosage*; D013997:Time Factors; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors; D064750:Rabeprazole
keywords: Impedance-pH monitoring; Non-erosive reflux disease; Proton pump inhibitor; Proximal reflux; Symptomatic reflux episodes