Characteristics of Symptomatic Reflux Episodes on Acid Suppressive Therapy

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Abstract
Persistent symptoms on acid suppressive therapy are due to either acid or nonacid gastroesophageal reflux (GER) episodes or are not related to reflux. To compare physical and chemical characteristics of GER episodes associated with symptoms in patients on acid suppressive therapy. Patients with persistent symptoms on acid suppressive therapy underwent combined impedance-pH monitoring. Reflux episodes were classified as acid if nadir pH was vs nonsymptomatic) as the outcome variable, reflux episode acidity was not significantly associated with symptoms (P = 0.40). Mixed reflux episodes were significantly associated with symptoms relative to liquid-only episodes (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.19–1.87, P = 0.0005), as were reflux episodes reaching the proximal esophagus compared with those reaching the distal esophagus only (OR 1.28, 95% CI 1.06–1.55, P = 0.012). 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).

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