We are not able to resolve this OAI Identifier to the repository landing page. If you are the repository manager for this record, please head to the Dashboard and adjust the settings.
SYMPTOMS ASSOCIATED TOWEAKLY ACIDIC REFLUX AND
ESOPHAGEAL MOTILITY ABNORMALITIES ARE COMMON
FINDINGS IN PATIENTS WITH NCCP NON-RESPONDING TO PPI
THERAPY
Background and aim: Proton pump inhibitor (PPI) therapy has been demonstrated
to be less effective on symptom relief in patients with non-cardiac
chest-pain (NCCP) than in those with heartburn. Data on the potential causes
of this reduced response rate are lacking.
Aim: To assess the frequency of esophageal motility abnormalities and reflux
disease in NCCP non-responders patients.
Material and methods: Consecutive NCCP patients non-responders to PPI
(<50%) underwent manometry and impedance-pH testing (MII-pH) while
on or off-therapy. Manometric pattern was defined according to international
criteria as Normal peristalsis (NP), Ineffective Esophageal Motility
(IEM), Distal Esophageal Spasm (DES), Nutcracker Esophagus (NE).We also
measured esophageal acid exposure time (AET; % pH<4), reflux episodes
(acid/weakly acidic) and symptom-reflux association using both symptom
association probability (SAP+ if = 95%) and symptom index (SI+ if =
50%).
Results: Ninety-seven NCCP patients (55F/42M) were enrolled. At manometry
testing, NP was found in 62 (64%) patients, 23 (24%) had DES, 9 (9%) had
NE and 3 (3%) had IEM. As to MII-pH monitoring (44 on- and 53 patients
off-PPI), we found 13 (13%) patients with an abnormal AET, although 4
(4%) of them were on-PPI. Out of the remaining 84 (87%) patients, 8 (8%)
had a positive SAP/SI to acid reflux only, 31 (32%) to weakly acidic reflux
only and 11 (11%) to both acid and weakly acidic reflux (4 patient were
positive considering both refluxes as a whole). Thirty-four (35%) patients had
no association between reflux and symptoms and out of them 23 (23%) had
NP (i.e. functional chest-pain). Thus, at manometry testing 35 (36%) patients
had esophageal motility abnormalities, while at MII-pH monitoring 13 (13%)
had acid GERD, 8 (8%) had SI/SAP+ to acid (i.e. hypersensitive esophagus to
acid), 31 (32%) had SI/SAP+ to weakly acidic (i.e. weakly acidic GERD) and
11 (11%) had SI/SAP+ to both reflux (i.e. mixed GERD).
Conclusions: Symptoms related to weakly acidic reflux and esophageal
motility abnormalities are very common in NCCP patients non-responding to
PPI therapy and may be responsible for the persistence of symptoms in the
majority of these patients
Is data on this page outdated, violates copyrights or anything else? Report the problem now and we will take corresponding actions after reviewing your request.