{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T05:24:20Z","timestamp":1792301060435,"version":"4.4.0"},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2013,10,3]],"date-time":"2013-10-03T00:00:00Z","timestamp":1380758400000},"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":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Non\u2010erosive reflux disease (<jats:styled-content style=\"fixed-case\">NERD<\/jats:styled-content>) patients are more sensitive than erosive esophagitis patients to weakly acidic reflux and to the presence of gas in the refluxate. Intra\u2010esophageal acid perfusion sensitizes esophageal receptors to mechanical and chemical stimuli.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>To establish whether acid sensitization plays a role in the perception of weakly acidic and mixed reflux episodes, 29 <jats:styled-content style=\"fixed-case\">NERD<\/jats:styled-content> patients, responders and 14 non\u2010responders to proton pump inhibitors (<jats:styled-content style=\"fixed-case\">PPI<\/jats:styled-content>s), underwent pH\u2010impedance monitoring. Non\u2010responders repeated the study while on <jats:styled-content style=\"fixed-case\">PPI<\/jats:styled-content>s. To assess the effect of acid exposure on symptom perception, the time period with pH below 4 was measured in 15\u2010 and 30\u2010minute time\u2010windows preceding the onset of each reflux episode.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>Considering weakly acidic and mixed refluxes, both in responder and non\u2010responder patients (off <jats:styled-content style=\"fixed-case\">PPI<\/jats:styled-content>s), the symptomatic refluxes were preceded by a significantly higher cumulative acid exposure than the asymptomatic refluxes. In all patients, following acid reflux, the percentage of symptomatic weakly acidic reflux episodes was significantly higher than that of asymptomatic refluxes. Non\u2010responder patients, off\u2010treatment, were characterized by a lower proportion of weakly acidic reflux and mixed reflux episodes. In the non\u2010responder patients on <jats:styled-content style=\"fixed-case\">PPI<\/jats:styled-content>, only mixed and weakly symptomatic reflux episodes were preceded by a higher cumulative acid exposure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions &amp; Inferences<\/jats:title><jats:p>In <jats:styled-content style=\"fixed-case\">NERD<\/jats:styled-content> patients, spontaneous acid reflux enhances subsequent reflux perception, regardless of acidity or liquid\/mixed composition of episodes; in non\u2010responder patients on <jats:styled-content style=\"fixed-case\">PPI<\/jats:styled-content>s, only the perception of mixed and weakly acidic reflux episodes seems to be mediated by a preceding acid exposure.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.12239","type":"journal-article","created":{"date-parts":[[2013,10,12]],"date-time":"2013-10-12T01:54:13Z","timestamp":1381542853000},"page":"108-114","source":"Crossref","is-referenced-by-count":16,"title":["Acid reflux episodes sensitize the esophagus to perception of weakly acidic and mixed reflux in non\u2010erosive reflux disease patients"],"prefix":"10.1111","volume":"26","author":[{"given":"S.","family":"Emerenziani","sequence":"first","affiliation":[{"name":"Unit of Digestive Disease Campus Bio Medico University Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Ribolsi","sequence":"additional","affiliation":[{"name":"Unit of Digestive Disease Campus Bio Medico University Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. P. L.","family":"Guarino","sequence":"additional","affiliation":[{"name":"Unit of Digestive Disease Campus Bio Medico University Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Balestrieri","sequence":"additional","affiliation":[{"name":"Unit of Digestive Disease Campus Bio Medico University Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Altomare","sequence":"additional","affiliation":[{"name":"Unit of Digestive Disease Campus Bio Medico University Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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