Nonerosive reflux disease (NERD) is the most common form of gastroesophageal reflux disease.
While the role of acid reflux has been established, the relevance of nonacid reflux in generating symptoms in nonerosive reflux disease is unknown.
Dr Edoardo Savarino and colleagues from Italy evaluated the diagnostic utility of impedance-pH monitoring in nonerosive reflux disease patients.
Patients with typical reflux symptoms and normal endoscopy underwent a combined impedance-pH monitoring off proton pump inhibitor therapy.
Previously investigated 48 healthy volunteers served as controls.
|42% had abnormal % time pH less than 4|
|The American Journal of Gastroenterology |
The team calculated distal esophageal acid exposure, number of acid and nonacid reflux episodes, 2-minute window symptom index, and symptom association probability.
Between 2004 and 2007, 150 nonerosive reflux disease patients reported symptoms during the impedance-pH monitoring.
The team noted that nonerosive reflux disease patients had more reflux episodes compared with healthy volunteers.
The research team found that 42% of patients had abnormal % time pH less than 4.
Among 87 patients with normal % time pH less than 4, 15% had a positive symptom association probability for acid, 12% for nonacid reflux, and 5% for both.
Classifying patients with symptomatic nonacid reflux as having a hypersensitive esophagus reduced the number of patients with functional heartburn from 43% to 26%.
Dr Savarino’s team concluded, “Monitoring for nonacid reflux in nonerosive reflux disease patients reduces the proportion of patients classified as having ‘functional heartburn’.”
“Studies assessing the clinical implications of these findings are warranted.”