Characteristics of Symptomatic Reflux Episodes on Acid Suppressive Therapy

Tutuian, Radu; Vela, Marcelo F.; Hill, Elizabeth G.; Mainie, Inder; Agrawal, Amit; Castell, Donald O.

doi:10.1111/j.1572-0241.2008.01791.x

Cited by 148 publications

(134 citation statements)

References 20 publications

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“…[13][14][15][16][17] The mean proportion of acid reflux episodes that were symptomatic was 53% (95% CI: 50-56%), which was similar to the mean proportion of weakly acidic or weakly alkaline reflux episodes that were symptomatic (47%; 95% CI: 44-50%). 13,15,17 In a study that assessed heartburn and regurgitation separately, and in which participants could report more than one symptom during each symptom event, symptomatic acid reflux episodes were just as commonly associated with Search results combined, duplicates removed (n = 316)…”

supporting

confidence: 55%

Systematic review: role of acid, weakly acidic and weakly alkaline reflux in gastro‐oesophageal reflux disease

Boeckxstaens

Smout

2010

Aliment Pharmacol Ther

117

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Aliment Pharmacol Ther 2010; 32: 334–343SummaryBackground The importance of weakly acidic and weakly alkaline reflux in gastro‐oesophageal reflux disease (GERD) is gaining recognition.Aim To quantify the proportions of reflux episodes that are acidic (pH <4), weakly acidic (pH 4–7) and weakly alkaline (pH >7) in adult patients with GERD, and to evaluate their correlation with symptoms.Methods Studies were identified by systematic PubMed and Embase searches. Data are presented as sample‐size weighted means and 95% confidence intervals.Results In patients with GERD taking a proton pump inhibitor (PPI), 80% (76–84%) of reflux episodes were weakly acidic or weakly alkaline and 83% (78–88%) of reflux symptom episodes were associated with weakly acidic or weakly alkaline reflux episodes. In patients with GERD not taking a PPI, 63% (59–67%) of reflux episodes were acidic and 72% (57–87%) of reflux symptom episodes were associated with acid reflux episodes. Six studies presented data separately for weakly alkaline reflux, which accounted for <5% of all reflux episodes, both on and off PPI therapy.Conclusions Weakly acidic reflux underlies the majority of reflux episodes in patients with GERD on PPI therapy, and is the main cause of reflux symptoms occurring despite PPI therapy.

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supporting

confidence: 55%

Systematic review: role of acid, weakly acidic and weakly alkaline reflux in gastro‐oesophageal reflux disease

Boeckxstaens

Smout

2010

Aliment Pharmacol Ther

117

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“…The concept of using oesophageal pH alone as a marker of reflux has inherent failings because of the effects of nonacid and gaseous reflux. Combined monitoring with electrical impedance shows that nonacid reflux continues despite acid suppression [Zerbib et al 2008;Mainie et al 2006) and may be a mixture of liquid and gas which is associated with respiratory symptoms regardless of pH [Tutuian et al 2008]. New techniques for directly measuring the pH of aerosolised liquids in the pharynx using a minimally invasive probe are promising.…”

Section: Investigationmentioning

confidence: 99%

Airway reflux, cough and respiratory disease

Molyneux

Morice

2011

Therapeutic Advances in Chronic Disease

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It is increasingly accepted that the effects of gastro-oesophageal reflux are not limited to the gastrointestinal tract. The adjacent respiratory structures are also at risk from material ejected from the proximal oesophagus as a result of the failure of anatomical and physiological barriers. There is evidence of the influence of reflux on several respiratory and otorhinological conditions and although in many cases the precise mechanism has yet to be elucidated, the association alone opens potential novel avenues of therapy to clinicians struggling to treat patients with apparently intractable respiratory complaints. This review provides a description of the airway reflux syndrome, its effects on the lung and current and future therapeutic options.

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“…In addition, it allows us to evaluate the proximal extent of the refluxate, a factor which has been shown to be associated with symptom perception. (25,26) Taken together, MII-pH has allowed for a redefinition of the classification of non-erosive reflux disease, as patients with a positive symptom association for AR and NAR events are regarded as having a hypersensitive oesophagus, whereas patients with a negative symptom association are deemed to have functional heartburn. (27) The management of hypersensitive oesophagus and functional heartburn includes pain modulators and low-dose antidepressants in the appropriate clinical setting.…”

Section: Evaluation Of Oesophageal Functionmentioning

confidence: 99%

Current status of functional gastrointestinal evaluation in clinical practice

Ang

Fock²,

Law³

2015

smedj

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Neurogastroenterology and motility disorders of the gastrointestinal (GI) tract encompass a broad spectrum of diseases involving the GI tract and central nervous system. They have varied pathophysiology, clinical presentation and management, and make up a substantial proportion of outpatient clinic visits. Typically, patients experience persistent symptoms referable to the GI tract despite normal endoscopic and radiologic findings. An appropriate evaluation is thus important in the patient's care. Advances in technology and understanding of the disease pathophysiology have provided better insight into the physiological basis of disease and a more rational approach to patient management. While technological advances serve to explain patients' persistent symptoms, they should be balanced against the costs of diagnostic tests. This review highlights the GI investigative modalities employed to evaluate patients with persistent GI symptoms in the absence of a structural lesion, with particular emphasis on investigative modalities available locally and the clinical impact of such tools.

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Characteristics of Symptomatic Reflux Episodes on Acid Suppressive Therapy

Abstract: The majority of reflux episodes on acid suppressive therapy are asymptomatic. Reflux episodes extending proximally and having a mixed (liquid-gas) composition are significantly associated with symptoms, irrespective of whether pH is acid (<4) or nonacid (>/=4).

Cited by 148 publications

References 20 publications

Systematic review: role of acid, weakly acidic and weakly alkaline reflux in gastro‐oesophageal reflux disease

Systematic review: role of acid, weakly acidic and weakly alkaline reflux in gastro‐oesophageal reflux disease

Airway reflux, cough and respiratory disease

Current status of functional gastrointestinal evaluation in clinical practice

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