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The pathogenesis of persistent non-erosive reflux disease treated with proton-pump inhibitors as measured with the Symptom Index

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Abstract

Background

Non-erosive reflux disease (NERD) includes a heterogeneous patient group with varying clinical and pathophysiological characteristics. This study aims to elucidate the pathogenesis of persistent NERD despite of continuous proton-pump inhibitors (PPI) treatment using 24-h combined multichannel intraluminal impedance-pH monitoring (MII-pH).

Methods

We enrolled fifty-four consecutive Japanese patients with typical gastroesophageal reflux disease symptoms, despite treatment with 10-mg rabeprazole twice daily. All patients underwent upper endoscopy, esophageal high-resolution manometry (HRM), and 24-h MII-pH monitoring.

Results

Twenty-nine (53.7 %) of the patients had a positive and 25 (46.3 %) had a negative Symptom Index (SI). The number of mean reflux episodes over 24 h in an upright position was significantly greater in the SI-positive than the SI-negative group. The majority of episodes were non-acid reflux, while the proportion of proximal reflux episodes consisting of non-acid, liquid or mixed components were significantly greater in the SI-positive group in comparison to the SI-negative group (50.4 vs. 33.1 %, P < 0.001, 46.1 vs. 32.3 %, P < 0.001, 54.4 vs. 40.9 %, P < 0.001, respectively). The SI-positive group had a higher rate of abnormal motility as measured by HRM.

Conclusions

Reflux reaching the proximal esophagus and defective esophageal motility play key roles in the pathogenesis of NERD. The majority of PPI-resistant NERD patients showed no association with acid reflux. The SI patterns suggest that NERD patients are a heterogeneous group. Therefore, therapy may be tailored to each patient according to SI patterns.

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Ethical Statement

We conformed with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning Human and Animal Rights, and that we followed out policy concerning Informed Consent as shown on Springer.com.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, Osaka, 530-0012, Japan

    Hiroshi Yamashita, Kiyoshi Ashida, Shinpei Kawaguchi, Takumi Fukuchi, Yoshiaki Nagatani, Takashi Hasegawa, Hideaki Koga, Takaaki Eguchi, Satoshi Ubukata, Toshio Tanaka & Dai Ito

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  1. Hiroshi Yamashita
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  2. Kiyoshi Ashida
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  3. Shinpei Kawaguchi
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Correspondence to Hiroshi Yamashita.

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Yamashita, H., Ashida, K., Kawaguchi, S. et al. The pathogenesis of persistent non-erosive reflux disease treated with proton-pump inhibitors as measured with the Symptom Index. Esophagus 12, 50–56 (2015). https://doi.org/10.1007/s10388-014-0452-6

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  • DOI: https://doi.org/10.1007/s10388-014-0452-6

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