{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T07:04:31Z","timestamp":1789455871115,"version":"build-2803163510"},"reference-count":34,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2016,9,12]],"date-time":"2016-09-12T00:00:00Z","timestamp":1473638400000},"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":[[2017,3]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>On\u2010therapy impedance\u2010pH<\/jats:styled-content> monitoring in proton pump inhibitor (PPI<\/jats:styled-content>)\u2010refractory gastroesophageal reflux disease (GERD<\/jats:styled-content>) yielded conflicting results. We aimed to assess the diagnostic value of postreflux swallow\u2010induced peristaltic wave (PSPW<\/jats:styled-content>) index and mean nocturnal baseline impedance (MNBI<\/jats:styled-content>) in PPI<\/jats:styled-content>\u2010refractory heartburn.<\/jats:p><\/jats:sec>Methods<\/jats:title>On\u2010therapy impedance\u2010pH<\/jats:styled-content> tracings from 189 consecutive patients with PPI<\/jats:styled-content>\u2010refractory heartburn were blindly reviewed. Patients were subdivided into refractory reflux esophagitis (RRE<\/jats:styled-content>), healed reflux esophagitis (HRE<\/jats:styled-content>), non\u2010erosive reflux disease (NERD<\/jats:styled-content>), and functional heartburn (FH<\/jats:styled-content>) according to endoscopic and conventional impedance\u2010pH<\/jats:styled-content> findings. The diagnostic accuracy of PSPW<\/jats:styled-content> index and MNBI<\/jats:styled-content> in separating NERD<\/jats:styled-content> from FH<\/jats:styled-content> was assessed with receiver\u2010operating\u2010characteristic (ROC<\/jats:styled-content>) analysis. Objectively documented persistent reflux remission at 3\u2010year follow\u2010up in 53 patients who underwent laparoscopic fundoplication served to evaluate PSPW<\/jats:styled-content> index and MNBI<\/jats:styled-content> as independent predictors of PPI<\/jats:styled-content>\u2010refractory GERD<\/jats:styled-content> confirmed by positive surgical outcome.<\/jats:p><\/jats:sec>Key Results<\/jats:title>Median PSPW<\/jats:styled-content> index and MNBI<\/jats:styled-content> values were significantly lower in 39 RRE<\/jats:styled-content> (16%; 1145\u00a0\u03a9) than in 41 HRE<\/jats:styled-content> (25%; 1741\u00a0\u03a9) and in 68 NERD<\/jats:styled-content> (29%; 2374\u00a0\u03a9) patients, and in all three GERD<\/jats:styled-content> subgroups compared to 41 FH<\/jats:styled-content> cases (67%; 3488\u00a0\u03a9) (P<\/jats:italic><.008). At ROC<\/jats:styled-content> analysis, comparing NERD<\/jats:styled-content> to FH<\/jats:styled-content> the area under the curve was 0.886 with PSPW<\/jats:styled-content> index and 0.677 with MNBI<\/jats:styled-content> (P<\/jats:italic>=.005). PSPW<\/jats:styled-content> index was an independent predictor of PPI<\/jats:styled-content>\u2010refractory GERD<\/jats:styled-content> (odds ratio 0.6983, P<\/jats:italic>=.012).<\/jats:p><\/jats:sec>Conclusions & Inferences<\/jats:title>At on\u2010therapy impedance\u2010pH<\/jats:styled-content> monitoring, PSPW<\/jats:styled-content> index and MNBI<\/jats:styled-content> efficiently distinguish PPI<\/jats:styled-content>\u2010refractory NERD<\/jats:styled-content> from FH<\/jats:styled-content>. The PSPW<\/jats:styled-content> index represents an independent predictor of PPI<\/jats:styled-content>\u2010refractory GERD<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.12947","type":"journal-article","created":{"date-parts":[[2016,9,13]],"date-time":"2016-09-13T02:37:15Z","timestamp":1473734235000},"source":"Crossref","is-referenced-by-count":123,"title":["The added diagnostic value of postreflux swallow\u2010induced peristaltic wave index and nocturnal baseline impedance in refractory reflux disease studied with on\u2010therapy impedance\u2010pH monitoring"],"prefix":"10.1111","volume":"29","author":[{"given":"M.","family":"Frazzoni","sequence":"first","affiliation":[{"name":"Digestive Pathophysiology Unit Baggiovara Hospital Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"de Bortoli","sequence":"additional","affiliation":[{"name":"Department of Translational Research and New Technology in Medicine and Surgery University of Pisa Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Frazzoni","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences University of Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Tolone","sequence":"additional","affiliation":[{"name":"General and Bariatric Surgery Unit Department of Surgery 2nd University of Napoli Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Furnari","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit Department of Internal Medicine University of Genova Genova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Martinucci","sequence":"additional","affiliation":[{"name":"Department of Translational Research and New Technology in Medicine and Surgery University of Pisa Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V. 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