Identification of Different Phenotypes of Esophageal Reflux Hypersensitivity and Implications for Treatment

Belching in Gastroesophageal Reflux Disease: Literature Review

“…Yadlapati et al [ 5 ] showed as much as 42% of PPI-refractory GERD patients have pathological SGB. Our study [ 2 ] found that prevalence varies between reflux phenotypes with 37.7% in non-erosive reflux disease (NERD) (i.e., acid exposure time > 6%), 39.7% in reflux hypersensitivity (RH) (i.e., acid exposure time < 4% and positive symptom reflux association) and 22% in functional heartburn (FH) (i.e., acid exposure time < 4% and negative symptom reflux association). More importantly, SGB is potentially responsible for approximately 40% of typical reflux symptoms (heartburn, regurgitation or chest pain) in RH [ 2 ], and the severity of reflux symptoms correlates to the extent of SGB positively [ 14 ].…”

“…Therefore, clinicians have to pay attention to impedance tracing so that hidden SGB is not overlooked. As approximately 50–60% of the SGBs exist close to reflux episodes [ 2 , 6 ], manual editing of automatic analysis of all reflux episodes can identify pathologic SGB. It is important to evaluate to what extent SGB causes acid exposure or reflux symptom.…”

“…In this setting, SGB is possibly required for improving typical reflux symptoms along with the current mainstream therapy for PPI refractoriness [ 2 , 5 ]. On the basis of relevant literatures, we here propose a possible therapeutic approach for each reflux phenotype with excessive SGB.…”

“…Excessive SGB possibly accounts for approximately 40% of typical reflux symptoms [ 2 ]. Considering SGB hardly responds to pain modulators or PPIs, dual therapy (i.e., pain modulators and CBT) might be beneficial for easing reflux symptoms.…”

“…On the other hand, some patients predominantly complain of typical reflux symptoms rather than belching, even though excessive belching itself causes reflux symptoms [ 2 , 3 , 4 ]. Due to poor response to proton pump inhibitors (PPIs) therapy, those patients are often referred to specialists as PPI-refractory gastroesophageal reflux disease (GERD) [ 2 , 4 , 5 , 6 ]. Recent studies suggest that hidden SGB is a possible cause of PPI refractoriness in a deceptively large proportion of GERD.…”