Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Oct 7, 2013; 19(37): 6193-6198
Published online Oct 7, 2013. doi: 10.3748/wjg.v19.i37.6193
Acid and non-acid reflux in patients refractory to proton pump inhibitor therapy: Is gastroparesis a factor?
Anna Tavakkoli, Bisma A Sayed, Nicholas J Talley, Baharak Moshiree
Anna Tavakkoli, Bisma A Sayed, Nicholas J Talley, Baharak Moshiree, Department of Medicine, Columbia University Medical Center, New York, NY 10019, United States
Bisma A Sayed, Department of Sociology, University of Miami, Miami, FL 33136, United States
Nicholas J Talley, Faculty of Health, University of Newcastle, Newcastle, NSW 2308, Australia
Baharak Moshiree, Department of Gastroenterology, University of Miami, Miami, FL 33136, United States
Author contributions: Tavakkoli A contributed to the data analysis, drafting and editing of manuscript; Sayed BA contributed to the statistical analysis; Talley NJ contributed to the reviewing and editing of manuscript; Moshiree B conceived and designed project and editing of manuscript.
Correspondence to: Baharak Moshiree, MD, Department of Gastroenterology, University of Miami, 1475 NW 12th Ave, 1st floor, Miami, FL 33136, United States.
Telephone: +1-305-2438644 Fax: +1-305-2433762
Received: June 13, 2013
Revised: July 14, 2013
Accepted: July 17, 2013
Published online: October 7, 2013

AIM: To determine whether an increased number and duration of non-acid reflux events as measured using the multichannel intraluminal impedance pH (MII-pH) is linked to gastroparesis (GP).

METHODS: A case control study was conducted in which 42 patients undergoing clinical evaluation for continued symptoms of gastroesophageal reflux disease (both typical and atypical symptoms) despite acid suppression therapy. MII-pH technology was used over 24 h to detect reflux episodes and record patients’ symptoms. Parameters evaluated in patients with documented GP and controls without GP by scintigraphy included total, upright, and supine number of acid and non-acid reflux episodes (pH < 4 and pH > 4, respectively), the duration of acid and non-acid reflux in a 24-h period, and the number of reflux episodes lasting longer than 5 min.

RESULTS: No statistical difference was seen between the patients with GP and controls with respect to the total number or duration of acid reflux events, total number and duration of non-acid reflux events or the duration of longest reflux episodes. The number of non-acid reflux episodes with a pH > 7 was higher in subjects with GP than in controls. In addition, acid reflux episodes were more prolonged (lasting longer than 5 min) in the GP patients than in controls; however, these values did not reach statistical significance. Thirty-five patients had recorded symptoms during the 24 h study and of the 35 subjects, only 9% (n = 3) had a positive symptom association probability (SAP) for acid/non-acid reflux and 91% had a negative SAP.

CONCLUSION: The evaluation of patients with a documented history of GP did not show an association between GP and more frequent episodes of non-acid reflux based on MII-pH testing.

Keywords: Gastroparesis, Non-acid gastroesophageal reflux, Acid gastroesophageal reflux, Multi-channel intraluminal impedance, Functional bowel disorder

Core tip: Gastroparesis (GP) has been thought to occur in about 8%-10% of patients who suffer from refractory gastroesophageal reflux disease (GERD). There have been no formal studies to date that have evaluated whether patients with refractory GERD additionally suffer from GP. Our study aimed to investigate whether patients who experience continued symptoms of GERD despite acid suppression therapy also concurrently have gastroparesis. By using multichannel intraluminal impedance pH technology, we were not able to find an association between patients with refractory GERD and gastroparesis.