{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T17:43:16Z","timestamp":1785519796436,"version":"3.56.0"},"reference-count":39,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2013,8,29]],"date-time":"2013-08-29T00:00:00Z","timestamp":1377734400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2014,1]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>A short\u2010course of proton pump inhibitors (PPI<\/jats:styled-content>s) is often used to confirm gastroesophageal reflux disease (GERD<\/jats:styled-content>). However, some patients with PPI<\/jats:styled-content> responsive heartburn do not seem to have evidence of GERD<\/jats:styled-content> on impedance\u2010pH monitoring (MII\u2010pH). The aim of the study was to evaluate patients with reflux symptoms and a negative endoscopy, who well respond to PPI<\/jats:styled-content>s with MII\u2010pH.<\/jats:p><\/jats:sec>Methods<\/jats:title>We enrolled 312 patients with GERD<\/jats:styled-content> symptoms and negative endoscopy: 144 reported well\u2010controlled symptoms after 8\u2010week PPI<\/jats:styled-content>s and 155 were non\u2010responders. Symptom relief was evaluated with GERD<\/jats:styled-content> Impact Scale and visual analog scale score. All patients underwent MII\u2010pH off\u2010therapy. Thirteen patients were excluded from analysis. Patients were grouped as follows: non\u2010erosive reflux disease (NERD<\/jats:styled-content>; increased acid exposure time, AET<\/jats:styled-content>); hypersensitive esophagus (HE<\/jats:styled-content>; normal AET<\/jats:styled-content>, positive symptom association, SI<\/jats:styled-content>\/SAP<\/jats:styled-content>); MII\u2010pH\u2010\/PPI<\/jats:styled-content>+ (normal AET<\/jats:styled-content>, negative SI<\/jats:styled-content>\/SAP<\/jats:styled-content>) in the responder group; MII\u2010pH\u2010\/PPI<\/jats:styled-content>\u2010 in non\u2010responders.<\/jats:p><\/jats:sec>Key Results<\/jats:title>MII\u2010pH in PPI<\/jats:styled-content> responders (symptom relief during PPI<\/jats:styled-content> therapy > 75%) showed: 79\/144 NERD<\/jats:styled-content> (54.9%); 37\/144 HE<\/jats:styled-content> (25.7%); 28\/144 MII\u2010pH\u2010\/PPI<\/jats:styled-content>+ (19.4%). MII\u2010pH\u2010\/PPI<\/jats:styled-content>+ patients reported the same symptom relief when compared with NERD<\/jats:styled-content> and HE<\/jats:styled-content>. In non\u2010responder (symptom relief during PPI<\/jats:styled-content> therapy < 50%) group, 27\/155 patients were NERD<\/jats:styled-content> (17.4%); 53\/155 were HE<\/jats:styled-content> (34.2%); 75\/155 were MII\u2010pH\u2010\/PPI<\/jats:styled-content>\u2010 (48.4%). NERD<\/jats:styled-content> diagnosis was significantly higher in responder group (p\u00a0<\u00a00.01).<\/jats:p><\/jats:sec>Conclusions & Inferences<\/jats:title>In a substantial subgroup of patients responding to PPI<\/jats:styled-content> with typical reflux symptoms, the diagnosis of GERD<\/jats:styled-content> cannot be confirmed with pH\u2010impedance monitoring. Proton pump inhibitor response and presence of typical symptoms are thus not reliable predictors of the diagnosis and antireflux surgery should always be preceded by reflux monitoring.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.12221","type":"journal-article","created":{"date-parts":[[2013,8,29]],"date-time":"2013-08-29T10:25:03Z","timestamp":1377771903000},"page":"28-35","source":"Crossref","is-referenced-by-count":78,"title":["Proton pump inhibitor responders who are not confirmed as GERD<\/scp> patients with impedance and pH monitoring: who are they?"],"prefix":"10.1111","volume":"26","author":[{"given":"N.","family":"de Bortoli","sequence":"first","affiliation":[{"name":"Division of Gastroenterology University of Pisa Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Martinucci","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology University of Pisa Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Savarino","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology University of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Bellini","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology University of Pisa Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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