Gastroesophageal Reflux Disease Poorly Responsive to Single-Dose Proton Pump Inhibitors in Patients without Barrett's Esophagus: Acid Reflux, Bile Reflux, or Both?

• DOI: 10.1111/j.1572-0241.2004.04171.x
• Publication Date: 2004-06-07T08:37:22Z
• Authors: J. Tack; G. Koek; I. Demedts; D. Sifrim; J. Janssens
• Keywords: Heartburn; Reflux esophagitis; Esophagitis; Esophageal disease; Bile reflux; Esophageal pH monitoring

OBJECTIVES Studies using ambulatory pH and esophageal bile reflux monitoring (Bilitec®) have shown that both acid duodeno-gastro-esophageal (DGER) frequently occur in patients with gastroesophageal disease (GERD). A subset of GERD has persistent symptoms spite standard doses proton pump inhibitors (PPIs). The aim the present study was to investigate role DGER poorly responsive PPIs. METHODS Sixty-five (32 men, 44 ± 2 yr) without Barrett's esophagus heartburn or regurgitation during PPI were studied. They underwent upper gastrointestinal endoscopy simultaneous 24-h Bilitec® while PPIs continued. RESULTS Thirty-three (51%) had esophagitis. Seven (11%) only pathological exposure, 25 (38%) 17 (26%) exposure DGER. Acid under positive 37%, but adding increased diagnoses 75%. Patients esophagitis similar significantly higher than those highest prevalence found DGER; did not differ according type reflux. CONCLUSIONS Combined is superior alone demonstrating ongoing medically disease.