Characteristics of symptomatic reflux episodes on acid suppressive therapy

Radu Tutuian, Marcelo F. Vela, Elizabeth G. Hill, Inder Mainie, Amit Agrawal, Donald O. Castell

Research output: Contribution to journalArticle

110 Citations (Scopus)

Abstract

BACKGROUND: Persistent symptoms on acid suppressive therapy are due to either acid or nonacid gastroesophageal reflux (GER) episodes or are not related to reflux. AIM: To compare physical and chemical characteristics of GER episodes associated with symptoms in patients on acid suppressive therapy. METHODS: Patients with persistent symptoms on acid suppressive therapy underwent combined impedance-pH monitoring. Reflux episodes were classified as acid if nadir pH was <4.0, and nonacid if it remained at ≥4.0, separated into liquid-only or mixed (liquid-gas), and considered to reach the proximal esophagus if liquid was present 15 cm above the lower esophageal sphincter (LES). Reflux episodes were considered symptomatic if patients recorded a symptom within 5 min after the reflux episode. Risk factors of symptomatic reflux episodes were identified using multivariable generalized estimating equations (GEEs). RESULTS: One hundred twenty patients (85 women, median age 54 yr, range 18-85 yr) recorded 3,547 reflux episodes (84.3% nonacid, 50.6% mixed), of which 468 (13.2%) were symptomatic. Based on multivariable GEE analysis with episode-level symptom status (symptomatic 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). CONCLUSION: 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).

Original languageEnglish (US)
Pages (from-to)1090-1096
Number of pages7
JournalAmerican Journal of Gastroenterology
Volume103
Issue number5
DOIs
StatePublished - May 2008
Externally publishedYes

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Acids
Esophagus
Gastroesophageal Reflux
Therapeutics
Gases
Odds Ratio
Confidence Intervals
Lower Esophageal Sphincter
Electric Impedance

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Tutuian, R., Vela, M. F., Hill, E. G., Mainie, I., Agrawal, A., & Castell, D. O. (2008). Characteristics of symptomatic reflux episodes on acid suppressive therapy. American Journal of Gastroenterology, 103(5), 1090-1096. https://doi.org/10.1111/j.1572-0241.2008.01791.x

Characteristics of symptomatic reflux episodes on acid suppressive therapy. / Tutuian, Radu; Vela, Marcelo F.; Hill, Elizabeth G.; Mainie, Inder; Agrawal, Amit; Castell, Donald O.

In: American Journal of Gastroenterology, Vol. 103, No. 5, 05.2008, p. 1090-1096.

Research output: Contribution to journalArticle

Tutuian, R, Vela, MF, Hill, EG, Mainie, I, Agrawal, A & Castell, DO 2008, 'Characteristics of symptomatic reflux episodes on acid suppressive therapy', American Journal of Gastroenterology, vol. 103, no. 5, pp. 1090-1096. https://doi.org/10.1111/j.1572-0241.2008.01791.x
Tutuian, Radu ; Vela, Marcelo F. ; Hill, Elizabeth G. ; Mainie, Inder ; Agrawal, Amit ; Castell, Donald O. / Characteristics of symptomatic reflux episodes on acid suppressive therapy. In: American Journal of Gastroenterology. 2008 ; Vol. 103, No. 5. pp. 1090-1096.
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N2 - BACKGROUND: Persistent symptoms on acid suppressive therapy are due to either acid or nonacid gastroesophageal reflux (GER) episodes or are not related to reflux. AIM: To compare physical and chemical characteristics of GER episodes associated with symptoms in patients on acid suppressive therapy. METHODS: Patients with persistent symptoms on acid suppressive therapy underwent combined impedance-pH monitoring. Reflux episodes were classified as acid if nadir pH was <4.0, and nonacid if it remained at ≥4.0, separated into liquid-only or mixed (liquid-gas), and considered to reach the proximal esophagus if liquid was present 15 cm above the lower esophageal sphincter (LES). Reflux episodes were considered symptomatic if patients recorded a symptom within 5 min after the reflux episode. Risk factors of symptomatic reflux episodes were identified using multivariable generalized estimating equations (GEEs). RESULTS: One hundred twenty patients (85 women, median age 54 yr, range 18-85 yr) recorded 3,547 reflux episodes (84.3% nonacid, 50.6% mixed), of which 468 (13.2%) were symptomatic. Based on multivariable GEE analysis with episode-level symptom status (symptomatic 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). CONCLUSION: 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).

AB - BACKGROUND: Persistent symptoms on acid suppressive therapy are due to either acid or nonacid gastroesophageal reflux (GER) episodes or are not related to reflux. AIM: To compare physical and chemical characteristics of GER episodes associated with symptoms in patients on acid suppressive therapy. METHODS: Patients with persistent symptoms on acid suppressive therapy underwent combined impedance-pH monitoring. Reflux episodes were classified as acid if nadir pH was <4.0, and nonacid if it remained at ≥4.0, separated into liquid-only or mixed (liquid-gas), and considered to reach the proximal esophagus if liquid was present 15 cm above the lower esophageal sphincter (LES). Reflux episodes were considered symptomatic if patients recorded a symptom within 5 min after the reflux episode. Risk factors of symptomatic reflux episodes were identified using multivariable generalized estimating equations (GEEs). RESULTS: One hundred twenty patients (85 women, median age 54 yr, range 18-85 yr) recorded 3,547 reflux episodes (84.3% nonacid, 50.6% mixed), of which 468 (13.2%) were symptomatic. Based on multivariable GEE analysis with episode-level symptom status (symptomatic 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). CONCLUSION: 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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