Weakly acidic refluxes have a major role in the pathogenesis of @entity7080 inhibitor-resistant XXXX .

@entity1 @entity7080 @entity16 @entity354 @entity10003
BACKGROUND: In @entity1 with heartburn that persists despite @entity7080 inhibitor (PPI) therapy, @entity354 is found rarely, and its pathogenesis has been scarcely studied. AIM: To assess reflux parameters by impedance-pH monitoring in PPI-resistant @entity354 . METHODS: Impedance-pH monitoring was performed on PPI therapy in @entity1 with symptomatic @entity354 detected despite standard or high-dose PPI therapy of at least 8-week duration. RESULTS: Twenty @entity1 , ten on once daily and ten on twice daily PPI regimens, were studied. The gastric acid exposure time (per cent time @entity10003 ) ranged from 10% to 81% and was >30% in 70% of cases, but the oesophageal acid exposure time (per cent time @entity10003 ) was abnormal in 20% of @entity1 only. The number of acid, weakly acidic and weakly alkaline refluxes was abnormal in 25%, 100% and 15% of @entity1 , respectively. CONCLUSIONS: Weakly acidic refluxes were above the normal range in all cases, whereas acid reflux parameters and weakly alkaline refluxes were normal in the vast majority of cases. Gastric acid secretion, with consequent intra-gastric pepsins activation, persists despite ongoing PPI therapy and activated pepsins may well be present in weakly acidic refluxes. As activated pepsins maintain their proteolytic activity in a weakly acidic environment, they may be responsible for @entity16 . We conclude that weakly acidic refluxes have a major role in the pathogenesis of PPI-resistant @entity354 . Therapeutic interventions in @entity1 with PPI-resistant @entity354 should be tailored on the basis of impedance-pH-monitoring results.
