caa a22 4500 606204229 CHVBK 20210128101001.0 cr unu---uuuuu 210128e20150101xx s 000 0 eng 10.1007/s10388-014-0452-6 doi (NATIONALLICENCE)springer-10.1007/s10388-014-0452-6 The pathogenesis of persistent non-erosive reflux disease treated with proton-pump inhibitors as measured with the Symptom Index [Elektronische Daten] [Hiroshi Yamashita, Kiyoshi Ashida, Shinpei Kawaguchi, Takumi Fukuchi, Yoshiaki Nagatani, Takashi Hasegawa, Hideaki Koga, Takaaki Eguchi, Satoshi Ubukata, Toshio Tanaka, Dai Ito] Background: Non-erosive reflux disease (NERD) includes a heterogeneous patient group with varying clinical and pathophysiological characteristics. This study aims to elucidate the pathogenesis of persistent NERD despite of continuous proton-pump inhibitors (PPI) treatment using 24-h combined multichannel intraluminal impedance-pH monitoring (MII-pH). Methods: We enrolled fifty-four consecutive Japanese patients with typical gastroesophageal reflux disease symptoms, despite treatment with 10-mg rabeprazole twice daily. All patients underwent upper endoscopy, esophageal high-resolution manometry (HRM), and 24-h MII-pH monitoring. Results: Twenty-nine (53.7%) of the patients had a positive and 25 (46.3%) had a negative Symptom Index (SI). The number of mean reflux episodes over 24h in an upright position was significantly greater in the SI-positive than the SI-negative group. The majority of episodes were non-acid reflux, while the proportion of proximal reflux episodes consisting of non-acid, liquid or mixed components were significantly greater in the SI-positive group in comparison to the SI-negative group (50.4 vs. 33.1%, P<0.001, 46.1 vs. 32.3%, P<0.001, 54.4 vs. 40.9%, P<0.001, respectively). The SI-positive group had a higher rate of abnormal motility as measured by HRM. Conclusions: Reflux reaching the proximal esophagus and defective esophageal motility play key roles in the pathogenesis of NERD. The majority of PPI-resistant NERD patients showed no association with acid reflux. The SI patterns suggest that NERD patients are a heterogeneous group. Therefore, therapy may be tailored to each patient according to SI patterns. The Japan Esophageal Society and Springer Japan, 2014 Nonerosive reflux disease (NERD) nationallicence Combined multichannel intraluminal impedance-pH nationallicence Monitoring (MII-pH) nationallicence High-resolution manometry (HRM) nationallicence Symptom Index (SI) nationallicence Yamashita Hiroshi Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut Ashida Kiyoshi Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut Kawaguchi Shinpei Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut Fukuchi Takumi Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut Nagatani Yoshiaki Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut Hasegawa Takashi Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut Koga Hideaki Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut Eguchi Takaaki Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut Ubukata Satoshi Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut Tanaka Toshio Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut Ito Dai Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut Esophagus Springer Japan 12/1(2015-01-01), 50-56 1612-9059 12:1<50 2015 12 10388 https://doi.org/10.1007/s10388-014-0452-6 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10388-014-0452-6 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Yamashita Hiroshi Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut NATIONALLICENCE 700 1- Ashida Kiyoshi Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut NATIONALLICENCE 700 1- Kawaguchi Shinpei Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut NATIONALLICENCE 700 1- Fukuchi Takumi Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut NATIONALLICENCE 700 1- Nagatani Yoshiaki Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut NATIONALLICENCE 700 1- Hasegawa Takashi Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut NATIONALLICENCE 700 1- Koga Hideaki Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut NATIONALLICENCE 700 1- Eguchi Takaaki Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut NATIONALLICENCE 700 1- Ubukata Satoshi Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut NATIONALLICENCE 700 1- Tanaka Toshio Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut NATIONALLICENCE 700 1- Ito Dai Department of Gastroenterology and Hepatology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata Kita-ku, 530-0012, Osaka, Japan aut NATIONALLICENCE 773 0- Esophagus Springer Japan 12/1(2015-01-01), 50-56 1612-9059 12:1<50 2015 12 10388