Document Detail

An analysis of persistent symptoms in acid-suppressed patients undergoing impedance-pH monitoring.
MedLine Citation:
PMID:  18356117     Owner:  NLM     Status:  MEDLINE    
BACKGROUND & AIMS: Despite proton-pump inhibitors (PPIs), patients may have persistent symptoms of gastroesophageal reflux disease (GERD). We aimed to identify symptom types and frequency experienced by patients on PPI therapy, and to identify the type of reflux, if any, associated with these symptoms. METHODS: A retrospective review was performed of 200 patients on PPI with GERD symptoms during ambulatory impedance-pH testing. The symptom index (SI) was determined for each symptom, and an SI of 50% or more was considered positive. Patients were divided into 2 groups: those with exclusively nonacid reflux (NAR) episodes and those with mixed-acid and NAR episodes. Symptom profiles were compared between these 2 groups. RESULTS: A total of 415 symptoms were reported by the 200 patients on twice-daily PPIs. Throat clearing was most common (24%). A total of 110 (27%) were typical symptoms and 305 (73%) were atypical. Typical symptoms were more likely to have a positive SI than atypical symptoms (48% vs 25%, P < .01). Eighty-four patients (42%) had a positive SI, and 116 patients (58%) had a negative SI. One hundred patients (50%) had only NAR; the other 100 had mixed acid and NAR. Heartburn (21% vs 63%, P < .01) and nausea (8% vs 44%, P < .01) were more likely associated with reflux in the mixed-acid and NAR group. CONCLUSIONS: Patients on PPIs still experience GERD symptoms. Impedance-pH monitoring identifies similar symptom associations with all types of reflux and also clarifies symptoms not related to any reflux.
Neeraj Sharma; Amit Agrawal; Janice Freeman; Marcelo F Vela; Donald Castell
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Publication Detail:
Type:  Journal Article     Date:  2008-03-20
Journal Detail:
Title:  Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association     Volume:  6     ISSN:  1542-7714     ISO Abbreviation:  Clin. Gastroenterol. Hepatol.     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-05     Completed Date:  2008-07-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101160775     Medline TA:  Clin Gastroenterol Hepatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  521-4     Citation Subset:  IM    
Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA.
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MeSH Terms
Age Distribution
Aged, 80 and over
Chi-Square Distribution
Cohort Studies
Education, Medical, Continuing
Electric Impedance
Follow-Up Studies
Gastric Acidity Determination
Gastroesophageal Reflux / drug therapy*,  epidemiology,  physiopathology*
Hydrogen-Ion Concentration
Middle Aged
Monitoring, Ambulatory / methods
Monitoring, Physiologic / methods*
Proton Pump Inhibitors / administration & dosage*
Retrospective Studies
Risk Assessment
Sex Distribution
Sickness Impact Profile
Reg. No./Substance:
0/Proton Pump Inhibitors
Comment In:
Clin Gastroenterol Hepatol. 2008 May;6(5):482-3   [PMID:  18378500 ]

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