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SYMPTOMS ASSOCIATED TOWEAKLY ACIDIC REFLUX AND\ud ESOPHAGEAL MOTILITY ABNORMALITIES ARE COMMON\ud FINDINGS IN PATIENTS WITH NCCP NON-RESPONDING TO PPI\ud THERAPY

By Savarino E., Zentilin P., Lo Cuoco D., Frazzoni M., De Bortoli N., Martinucci I., Casini V., Pace F., Barbera R., Bergonzi M., Di\ud Stefano M., Oppia F., Usai Satta P., Ricci G., De Bona M., De\ud Boni M., Sturniolo G.C. and Savarino V.

Abstract

Background and aim: Proton pump inhibitor (PPI) therapy has been demonstrated\ud to be less effective on symptom relief in patients with non-cardiac\ud chest-pain (NCCP) than in those with heartburn. Data on the potential causes\ud of this reduced response rate are lacking.\ud Aim: To assess the frequency of esophageal motility abnormalities and reflux\ud disease in NCCP non-responders patients.\ud Material and methods: Consecutive NCCP patients non-responders to PPI\ud (<50%) underwent manometry and impedance-pH testing (MII-pH) while\ud on or off-therapy. Manometric pattern was defined according to international\ud criteria as Normal peristalsis (NP), Ineffective Esophageal Motility\ud (IEM), Distal Esophageal Spasm (DES), Nutcracker Esophagus (NE).We also\ud measured esophageal acid exposure time (AET; % pH<4), reflux episodes\ud (acid/weakly acidic) and symptom-reflux association using both symptom\ud association probability (SAP+ if = 95%) and symptom index (SI+ if =\ud 50%).\ud Results: Ninety-seven NCCP patients (55F/42M) were enrolled. At manometry\ud testing, NP was found in 62 (64%) patients, 23 (24%) had DES, 9 (9%) had\ud NE and 3 (3%) had IEM. As to MII-pH monitoring (44 on- and 53 patients\ud off-PPI), we found 13 (13%) patients with an abnormal AET, although 4\ud (4%) of them were on-PPI. Out of the remaining 84 (87%) patients, 8 (8%)\ud had a positive SAP/SI to acid reflux only, 31 (32%) to weakly acidic reflux\ud only and 11 (11%) to both acid and weakly acidic reflux (4 patient were\ud positive considering both refluxes as a whole). Thirty-four (35%) patients had\ud no association between reflux and symptoms and out of them 23 (23%) had\ud NP (i.e. functional chest-pain). Thus, at manometry testing 35 (36%) patients\ud had esophageal motility abnormalities, while at MII-pH monitoring 13 (13%)\ud had acid GERD, 8 (8%) had SI/SAP+ to acid (i.e. hypersensitive esophagus to\ud acid), 31 (32%) had SI/SAP+ to weakly acidic (i.e. weakly acidic GERD) and\ud 11 (11%) had SI/SAP+ to both reflux (i.e. mixed GERD).\ud Conclusions: Symptoms related to weakly acidic reflux and esophageal\ud motility abnormalities are very common in NCCP patients non-responding to\ud PPI therapy and may be responsible for the persistence of symptoms in the\ud majority of these patients

Year: 2012
OAI identifier: oai:iris.unife.it:11392/1685497
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