Abstract
not responding (<50% improvement) to full dose PPI, pH-impedance ambulatory monitoring was performed on two occasions, off and on therapy, randomly, following stationarymanometry. Data obtained in 15 patients (F 11, mean age 47), showing a positive symptom-reflux association (SI and/or SAP), were compared to those of 27 NERD patients PPI-responders, with a positive SI and/or SAP (F 16, mean age 51). Reflux episodes were classified according to standardized protocols. Results: AET was pathological in 12/15 patients off PPI and in 1/15 patients on PPI. Overall, 2639 refluxes were analyzed; off therapy, non-responder patients, compared to responders, showed more frequent reflux episodes (mean 55±30 vs 37±16/24h), higher proportion of acidic (83±15 vs 68±12%) and of proximal refluxes (59±14 vs 34±9%), lower proportion of mixed (42±12 vs 55±14%) refluxes. During PPI therapy, in the non-responder patients, frequency of reflux episodes did not change, proportions of acidic decreased to 21%, weakly acidic refluxes increased to 79%; proportions of mixed (36±10%) and proximal refluxes (60±18%) remained unchanged. Analysis of gastric pH confirmed compliance and effectiveness of therapy in all patients. On therapy, in nonresponder patients, acidic, compared to weakly acidic reflux, was significantly associated with liquid-gas composition (OR 1.6 [1.13-2.26]) and with proximal extent (OR 1.6 [0.73.8]). No interaction between acidity, proximal extent and physical properties was observed in non-responder patients off PPI (OR 0.9 [0.6-1.4] and 1 [0.8-1.4]) and in PPI-responder patients (OR 1.2 [0.7-2.2] and 1 [0.7-1.6]). Conclusions: in PPI-resistant patients, during therapy, acidic content is associated with presence of gas and proximal spread of refluxate. It could be hypothesized that the interaction between chemical and physical properties are involved in the persistence of symptoms despite acid suppression in this subgroup of NERD patients.
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