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Impairment of chemical clearance and mucosal integrity distinguishes hypersensitive esophagus from functional heartburn

  • Original Article—Alimentary Tract
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Abstract

Background

Hypersensitive esophagus (HE) is defined by endoscopy-negative heartburn with a normal acid exposure time but positive symptom association probability (SAP) and/or symptom index (SI) on impedance–pH monitoring, and proton pump inhibitor (PPI) responsiveness. Functional heartburn (FH) is distinguished by negative SAP/SI and PPI refractoriness. The clinical value of SAP and SI has been questioned. We aimed to investigate whether impairment of chemical clearance and of mucosal integrity, expressed by the postreflux swallow-induced peristaltic wave (PSPW) index and the mean nocturnal baseline impedance (MNBI), characterize HE independently of SAP and SI.

Methods

Impedance–pH tracings from PPI-responsive endoscopy-negative patients, 125 with nonerosive reflux disease and 108 with HE, distinguished by an abnormal and a normal acid exposure time, and from 70 patients with FH were retrospectively selected and blindly reviewed.

Results

The mean PSPW index and MNBI were significantly lower in nonerosive reflux disease (30 %, 1378 Ω) than in HE (51 %; 2274 Ω) and in both of them as compared with FH (76 %; 3445 Ω) (P = 0.0001). Both the PSPW index (adjusted odds ratio 0.863, P = 0.001) and the MNBI (adjusted odds ratio 0.998, P = 0.001) were independent predictors of HE; with their combined assessment, the area under the curve on receiver operating characteristic analysis was 0.957. SAP and/or SI was positive in 67 of the 108 HE patients (62 %), whereas the PSPW index and/or MNBI was abnormal in 99 of the 108 HE patients (92 %; P < 0.0001).

Conclusions

HE is characterized by impairment of chemical clearance and mucosal integrity, which explains the increased reflux perception. When SAP and SI afford uncertain results, the PSPW index and MNBI should be analyzed.

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Author information

Authors and Affiliations

  1. Digestive Pathophysiology Unit, Baggiovara Hospital, Viale Giardini, 1355, 41100, Modena, Italy

    Marzio Frazzoni

  2. Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy

    Nicola de Bortoli, Irene Martinucci & Santino Marchi

  3. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

    Leonardo Frazzoni, Andrea Farioli & Lorenzo Fuccio

  4. Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy

    Manuele Furnari & Vincenzo Savarino

  5. General and Bariatric Surgery Unit, Department of Surgery, 2nd University of Napoli, Naples, Italy

    Salvatore Tolone

  6. Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy

    Edoardo Savarino

Authors
  1. Marzio Frazzoni
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  2. Nicola de Bortoli
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  3. Leonardo Frazzoni
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  4. Manuele Furnari
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  5. Irene Martinucci
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Correspondence to Marzio Frazzoni.

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Conflict of interest

The study was conducted without any financial support. The authors have no conflict of interest to declare.

Additional information

Selected in abstract form for a lecture in the Distinguished Abstract Plenary Session during Digestive Disease Week, May 24, 2016, held in San Diego, CA, USA.

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Frazzoni, M., de Bortoli, N., Frazzoni, L. et al. Impairment of chemical clearance and mucosal integrity distinguishes hypersensitive esophagus from functional heartburn. J Gastroenterol 52, 444–451 (2017). https://doi.org/10.1007/s00535-016-1226-9

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  • DOI: https://doi.org/10.1007/s00535-016-1226-9

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