Original articleAlimentary tractIncreased Proximal Reflux in a Hypersensitive Esophagus Might Explain Symptoms Resistant to Proton Pump Inhibitors in Patients With Gastroesophageal Reflux Disease
Section snippets
Patients
We included 18 patients with GERD, of whom 9 patients were PPI responders (5 men; age, 59 y), and 9 patients experienced refractory symptoms on PPI (2 men; age, 52 y). The latter category of patients was classified as partial PPI responders. A diagnosis of GERD was based on the observation of esophagitis during endoscopy and/or a pathologic acid exposure, both in combination with typical reflux symptoms off PPI. In GERD patients with complete response, typical reflux symptoms were absent during
Patients
In all 18 patients esophageal sensitivity measurements and the postprandial reflux protocol were completed. In 2 patients (1 responder, 1 partial responder) endoscopy could not be performed, such that no biopsy specimens were available for Ussing experiments.
No significant differences were found in ages or sex between complete and partial responders (age, 59 ± 4.9 vs 52 ± 6.4 y, P = .39; sex, 5 males vs 2 males, P = .34). The PPIs used were omeprazole, pantoprazole, and esomeprazole (8, 5, and
Discussion
Visceral hypersensitivity, impaired mucosal integrity, and differences in acidity and position of the acid pocket have been hypothesized to contribute to PPI-resistant symptoms in GERD patients. In the current study we showed that mucosal permeability and the position of the acid pocket are similar in PPI partial responders and responders and are therefore less likely to explain persistent symptoms. In contrast, esophageal sensitivity to distension and the number of reflux episodes with a
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Conflicts of interest The authors disclose no conflicts.