Approximately 20% of patients have persistent symptoms of gastro-oesophageal reflux despite proton pump inhibitor (PPI) therapy.
Dr Zerbib and colleagues from France assessed the determinants of reflux perception in patients on proton pump inhibitor therapy.
|High proximal extent of the refluxate is associated with reflux perception in patients|
The team evaluated 20 patients with typical gastro-oesophageal reflux symptoms (heartburn and/or regurgitation) despite double-dose proton pump inhibitor's.
The team performed ambulatory 24 h pH-impedance studies in all patients.
The research team then compared the characteristics of symptomatic and asymptomatic reflux episodes.
The team considered symptoms globally and separately for heartburn and regurgitation.
The researchers found a total of 1,273 reflux episodes.
Of these, 19% were acidic, 80% were weakly acidic and 1% were weakly alkaline reflux episodes.
The team noted that overall, 25% of reflux episodes were symptomatic.
The only factor associated with reflux perception was high proximal extent.
The team observed that, compared with regurgitation, reflux episodes associated with heartburn were more frequently pure liquid, acidic, and had a lower nadir pH.
Reflux episodes associated with heartburn were also more frequently preceded by acid reflux episodes, and had a longer reflux bolus clearance time.
Dr Zerbib's team concluded, "High proximal extent of the refluxate is the only factor associated with the reflux perception in patients on double-dose proton pump inhibitor.
"However, compared with regurgitation, composition of the refluxate, sensitisation of the esophagus by preceding acid exposure, and delayed bolus clearance appear to play a role in heartburn perception."