@entity354 in @entity1 with persistent symptoms despite XXXX inhibitors.

@entity1 @entity2749 @entity7080 @entity338 @entity354
BACKGROUND AND AIMS: Approximately 20% of @entity1 have persistent symptoms of @entity354 despite @entity7080 inhibitor (PPI) therapy. The aim of this study was to assess the determinants of @entity354 in @entity1 on PPI therapy. @entity1 AND METHODS: 20 @entity1 with typical @entity354 ( @entity338 ) despite double-dose PPIs (twice daily) were included in this study. Ambulatory 24 h pH-impedance studies were performed in all @entity1 . The characteristics of symptomatic and asymptomatic @entity2749 were compared. Symptoms were considered globally and separately for @entity338 . RESULTS: A total of 1273 @entity2749 were detected including 243 (19.1%) acidic, 1018 (80.0%) weakly acidic and 12 (0.9%) weakly alkaline @entity2749 . Overall, 312 (24.5%) @entity2749 were symptomatic. The only factor associated with @entity354 was high proximal extent (p = 0.037). Compared with regurgitation, @entity2749 associated with heartburn were more frequently pure liquid (p = 0.009) and acidic (p = 0.027), had a lower nadir pH (p<0.001), were more frequently preceded by acid @entity2749 (p<0.001) and had a longer reflux bolus clearance time (p<0.001). CONCLUSIONS: High proximal extent of the refluxate is the only factor associated with @entity354 in @entity1 on double-dose PPI. However, compared with regurgitation, composition of the refluxate, sensitisation of the oesophagus by preceding acid exposure and delayed bolus clearance appear to play a role in heartburn perception.
