Pathogenesis of Double-Dose Proton Pump Inhibitor-Resistant Non-Erosive Reflux Disease, and Mechanism of Reflux Symptoms and Gastric Acid Secretion-Suppressive Effect in the Presence or Absence of Helicobacter pylori Infection.
BACKGROUND
Various mechanisms have been suggested to be responsible for contributing to the occurrence of proton pump inhibitor (PPI)-resistant non-erosive reflux disease (NERD). The aims of this study were to clarify the pathogenesis of PPI-resistant NERD.


METHODS
Fifty-three patients with NERD, who had persistent reflux symptoms despite taking double-dose PPI, were included in this study. After excluding eosinophilic esophagitis (EoE) and primary esophageal motility disorder, esophageal impedance-pH monitoring was carried out. In symptom index (SI)-positive patients, the mechanism of SI positivity and the percent time with intragastric pH >4 were investigated according to the presence or absence of Helicobacter pylori infection.


RESULTS
One of the 53 patients had EoE, and 4 had primary esophageal motility disorder. Twenty-three and 2 patients were SI-positive for liquid and gas-only reflux respectively. Of 17 SI-positive, H. pylori-negative patients, 5 were SI-positive for acid reflux, whereas all of the H. pylori-positive patients were SI-positive for non-acid reflux. The percent time with intragastric pH >4 was significantly lower in the H. pylori-negative patients than in the H. pylori-positive patients.


CONCLUSIONS
The pathogenesis of double-dose PPI-resistant NERD was identified in 57%. In some of H. pylori-negative patients, acid-related symptoms were observed. However, in H. pylori-positive patients, these symptoms were excluded by taking double-dose PPI.
Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan.
Noriyuki
N
Kawami
Nana
N
Takenouchi
Mariko
M
Umezawa
Shintaro
S
Hoshino
Yuriko
Y
Hanada
Yoshimasa
Y
Hoshikawa
Hirohito
H
Sano
Yoshio
Y
Hoshihara
Tsutomu
T
Nomura
Eiji
E
Uchida
Katsuhiko
K
Iwakiri
D004351:Drug Resistance; D057765:Eosinophilic Esophagitis / Q000175:diagnosis; D015154:Esophageal Motility Disorders / Q000175:diagnosis; D050782:Esophageal pH Monitoring; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000382:microbiology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*
D054328:Proton Pump Inhibitors