Lower pH values of weakly acidic refluxes as determinants of heartburn perception in gastroesophageal reflux disease patients with normal esophageal acid exposure

Bortoli, Nicola de; Martinucci, Irene; Savarino, Edoardo; Franchi, Riccardo; Bertani, Lorenzo; Russo, Salvatore; Ceccarelli, L.; Costa, Francesco; Bellini, Massimo; Blandizzi, Corrado; Savarino, Vincenzo; Marchi, Santino

doi:10.1111/dote.12284

Cited by 16 publications

(19 citation statements)

References 43 publications

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“…However, the value of HRM in clinical practice has yet to be established fully Exclusion of severe esophageal motility disorders (i.e., achalasia) is important because such diseases can present with heartburn and regurgitation, which could lead to an erroneous diagnosis of GERD [122] . Ambulatory MII-pH has become the gold standard for investigating GERD, owing mainly to its ability to detect both acid and non-acid reflux [68,123] . Of particular importance, MII-pH has enabled the subdivision of patients with NERD into different subsets, including patients with an excess of acid and those with symptomatic non-acid reflux, and MII-pH has the ability to identify patients with FH whose symptoms are not GERD related and who must be excluded from the realm of GERD [6,56,109] .…”

Section: Resultsmentioning

confidence: 99%

“…In contrast, in agreement with the Rome Ⅲ criteria, patients with heartburn, normal upper endoscopy, physiological AET, and negative correspondence between symptoms and reflux and who fail to respond to PPIs are defined as having functional heartburn (FH) [8,9,60] . In this regard, the advent of MII-pH monitoring has improved the diagnostic yield of GERD patients, mainly by identifying a positive SAP or SI with weakly acidic or non-acid reflux [61][62][63][64][65][66][67][68] . In particular, if pH-metry and the patient's response to PPI therapy are compared with MII-pH, we can observe an underestimation of GERD patients [69,70] .…”

Section: Multichannel Intraluminal Impedance and Phmentioning

confidence: 99%

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Esophageal testing: What we have so far

Bortoli¹,

Martinucci²,

Bertani³

et al. 2016

WJGP

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Gastroesophageal reflux disease (GERD) is a common disorder of the gastrointestinal tract. In the last few decades, new technologies have evolved and have been applied to the functional study of the esophagus, allowing for the improvement of our knowledge of the pathophysiology of GERD. High-resolution manometry (HRM) permits greater understanding of the function of the esophagogastric junction and the risks associated with hiatal hernia. Moreover, HRM has been found to be more reproducible and sensitive than conventional water-perfused manometry to detect the presence of transient lower esophageal sphincter relaxation. Esophageal 24-h pH-metry with or without combined impedance is usually performed in patients with negative endoscopy and reflux symptoms who have a poor response to anti-reflux medical therapy to assess esophageal acid exposure and symptom-reflux correlations. In particular, esophageal 24-h impedance and pH monitoring can detect acid and non-acid reflux events. EndoFLIP is a recent technique poorly applied in clinical practice, although it provides a large amount of information about the esophagogastric junction. In the coming years, laryngopharyngeal symptoms could be evaluated with up and coming non-invasive or minimally invasive techniques, such as pepsin detection in saliva or pharyngeal pH-metry.

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Section: Resultsmentioning

confidence: 99%

Section: Multichannel Intraluminal Impedance and Phmentioning

confidence: 99%

Esophageal testing: What we have so far

Bortoli¹,

Martinucci²,

Bertani³

et al. 2016

WJGP

View full text Add to dashboard Cite

show abstract

“…The role of WAR in patients with typical refractory symptoms has almost always been studied in patients on PPIs. Few but intriguing data have been reported on WAR evaluated in patients off therapy, and it was confirmed that this type of chemical reflux can be associated with both heartburn and regurgitation …”

Section: War and Refractory Heartburnmentioning

confidence: 89%

“…Belching does not seem to facilitate acid reflux in healthy subjects . However, the presence of gas in the refluxate enhances reflux perception, is frequently associated with proximal extent of reflux, and occurs more frequently in patients who do not respond to acid‐suppressive treatment …”

Section: Aerophagia Gas Reflux and Supragastric Belching In The Patmentioning

confidence: 99%

Between GERD and NERD: the relevance of weakly acidic reflux

Bortoli

Ottonello

Zerbib³

et al. 2016

Annals of the New York Academy of Sciences

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Nonerosive reflux disease (NERD) is a common condition and the most frequent phenotype of gastroesophageal reflux disease (GERD). NERD is extremely heterogeneous and includes patients with negative endoscopy but abnormal esophageal acid exposure and/or positive reflux-symptom association analysis (hypersensitive esophagus). This segregation is only possible owing to the use of impedance-pH monitoring. Indeed, weakly acidic reflux represents one of the most common causes of refractory symptoms in patients evaluated off antisecretory therapy and, more importantly, during antisecretory drug treatment. Patients with heartburn who do not have any type of reflux underlying their symptoms (functional heartburn) must be excluded from the category of GERD. The drawbacks of impedance-pH are mainly due to the day-to-day variability of the test and the fact that the accuracy of the symptom-reflux correlation scores is often far from perfect. Some histopathological characteristics, such as dilated intercellular spaces, can be helpful in distinguishing patients with NERD through esophageal biopsies. Patients with NERD in whom acid is the main pathogenetic factor respond successfully to proton pump inhibitor therapy, while those with hypersensitive esophagus to weakly acidic reflux could be treated with reflux inhibitors or surgery, although further controlled studies are required.

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“…Despite the impaired acid secretion occurring in AG due to atrophy of the oxyntic mucosa, it is possible that nonacidic refluxes might develop and play as determinants of heartburn perception, as recently observed. [24] In fact, in a recent paper, Tenca et al [13] demonstrated that 24% of AG patients present gastroesophageal reflux at pH-impedence monitoring, irrespective of the presence of symptoms, confirming that reflux can occur in AG patients. In another study by Miceli et al, [11] it has been reported that 24% of AG patients complained of heartburn and 12% of acid regurgitation.…”

Section: Discussionmentioning

confidence: 99%

Upper gastrointestinal symptoms in autoimmune gastritis

et al. 2017

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Autoimmune gastritis is often suspected for its hematologic findings, and rarely the diagnosis is made for the presence of gastrointestinal symptoms. Aims of this cross-sectional study were to assess in a large cohort of patients affected by autoimmune gastritis the occurrence and the pattern of gastrointestinal symptoms and to evaluate whether symptomatic patients are characterized by specific clinical features.Gastrointestinal symptoms of 379 consecutive autoimmune gastritis patients were systematically assessed and classified following Rome III Criteria. Association between symptoms and anemia pattern, positivity to gastric autoantibodies, Helicobacter pylori infection, and concomitant autoimmune disease were evaluated.In total, 70.2% of patients were female, median age 55 years (range 17–83). Pernicious anemia (53.6%), iron deficiency anemia (34.8%), gastric autoantibodies (68.8%), and autoimmune disorders (41.7%) were present. However, 56.7% of patients complained of gastrointestinal symptoms, 69.8% of them had exclusively upper symptoms, 15.8% only lower and 14.4% concomitant upper and lower symptoms. Dyspepsia, subtype postprandial distress syndrome was the most represented, being present in 60.2% of symptomatic patients. Univariate and multivariate analyses showed that age <55 years (OR 1.6 [CI:1–2.5]), absence of smoking habit (OR 2.2 [CI:1.2–4]), and absence of anemia (OR 3.1 [CI:1.5–6.4]) were independent factors associated to dyspepsia.Autoimmune gastritis is associated in almost 60% of cases with gastrointestinal symptoms, in particular dyspepsia. Dyspepsia is strictly related to younger age, no smoking, and absence of anemia.

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Lower pH values of weakly acidic refluxes as determinants of heartburn perception in gastroesophageal reflux disease patients with normal esophageal acid exposure

Cited by 16 publications

References 43 publications

Esophageal testing: What we have so far

Esophageal testing: What we have so far

Between GERD and NERD: the relevance of weakly acidic reflux

Upper gastrointestinal symptoms in autoimmune gastritis

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