Pathogenesis of Double-Dose Proton Pump Inhibitor-Resistant Non-Erosive Reflux Disease, and Mechanism of Reflux Symptoms and Gastric Acid Secretion-Suppressive Effect in the Presence or Absence of Helicobacter pylori Infection
Pathogenesis of Double-Dose Proton Pump Inhibitor-Resistant Non-Erosive Reflux Disease, and Mechanism of Reflux Symptoms and Gastric Acid Secretion-Suppressive Effect in the Presence or Absence of Helicobacter pylori Infection
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DOI：
10.1159/000455834
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发表时间：
2017-01-01
期刊：
影响因子：
3.2
通讯作者：
Iwakiri, Katsuhiko
中科院分区：
文献类型：
--
作者：
Kawami, Noriyuki;Takenouchi, Nana;Iwakiri, Katsuhiko
背景：已提出多种机制导致质子泵抑制剂（PPI）耐药的非糜烂性反流病（NERD）的发生。本研究的目的是阐明 PPI 耐药 NERD 的发病机制。方法：本研究纳入了 53 名 NERD 患者，尽管他们服用双剂量 PPI，但仍出现反流症状。排除嗜酸性食管炎（EoE）和原发性食管动力障碍后，进行食管阻抗-pH监测。在症状指数（SP阳性患者）中，根据有无幽门螺杆菌感染，调查SI阳性的机制和胃内pH>4的时间百分比。结果：53例患者中，1例患有EoE，4例患有原发性食管动力障碍。仅液体和气体反流的SI阳性分别为23例和2例。在17例SI阳性中，H. 幽门螺杆菌阴性患者中，5 例胃酸反流 SI 阳性，而所有幽门螺杆菌阳性患者非胃酸反流 SI 阳性。幽门螺杆菌阴性患者胃内pH>4的时间百分比显着低于幽门螺杆菌阳性患者。结论：双剂量 PPI 耐药 NERD 的发病机制是 57% 中被识别。在一些 H. pylon 阴性患者中，观察到与酸相关的症状。然而，在幽门螺杆菌阳性患者中，通过服用双剂量 PPI 可以排除这些症状。 (C) 2017 S. Karger AG，巴塞尔
Background: Various mechanisms have been suggested to be responsible for contributing to the occurrence of proton pump inhibitor (PPI)-resistant non-erosive reflux disease (NERD). The aims of this study were to clarify the pathogenesis of PPI-resistant NERD. Methods: Fifty-three patients with NERD, who had persistent reflux symptoms despite taking double-dose PPI, were included in this study. After excluding eosinophilic esophagitis (EoE) and primary esophageal motility disorder, esophageal impedance-pH monitoring was carried out. In symptom index (SP-positive patients, the mechanism of SI positivity and the percent time with intragastric pH >4 were investigated according to the presence or absence of Helicobacter pylori infection. Results: One of the 53 patients had EoE, and 4 had primary esophageal motility disorder. Twenty-three and 2 patients were SI-positive for liquid and gas-only reflux respectively. Of 17 SI-positive, H. pylori-negative patients, 5 were SI-positive for acid reflux, whereas all of the H. pylori-positive patients were SI-positive for non-acid reflux. The percent time with intragastric pH >4 was significantly lower in the H. pylori-negative patients than in the H. pylori-positive patients. Conclusions: The pathogenesis of double-dose PPI-resistant NERD was identified in 57%. In some of H. pylon-negative patients, acid-related symptoms were observed. However, in H. pylori-positive patients,these symptoms were excluded bytaking double-dose PPI. (C) 2017 S. Karger AG, Basel