{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T05:24:22Z","timestamp":1792301062540,"version":"4.4.0"},"reference-count":46,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2020,6,22]],"date-time":"2020-06-22T00:00:00Z","timestamp":1592784000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Mean nocturnal baseline impedance (MNBI) and postreflux swallow\u2010induced peristaltic wave (PSPW) index are novel impedance\u2010based markers of reflux, but the effect of bile reflux on these metrics is unknown. The aim of this study was to evaluate bile reflux, MNBI, and PSPW index in patients with endoscopy\u2010negative GERD partially responsive to PPI therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All patients underwent off\u2010PPI endoscopy, esophageal manometry, multichannel intraluminal impedance pH (MII\u2010pH), and bile reflux monitoring. Abnormal esophageal acid exposure time (AET) was required for inclusion. Symptom intensity (using 10\u2010cm visual analog scales), and conventional and novel MII\u2010pH metrics were compared between patients with and without abnormal bile reflux.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>We evaluated 42 NERD patients (29 males, mean age: 53.4\u00a0\u00b1\u00a013.\u00a0years), mean AET 6.1\u00a0\u00b1\u00a02%, of which 21 had abnormal bile reflux (Group A, 10.2\u00a0\u00b1\u00a04.9%), and 21 had normal bile reflux (Group B, 0.4\u00a0\u00b1\u00a00.1%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.05 compared with Group A). Heartburn reporting on PPI was higher in Group A (7.2\u00a0\u00b1\u00a02.1 vs 5.8\u00a0\u00b1\u00a00.9; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.002), but AET, number of reflux events (acidic and weakly acidic), did not differ between the two groups. However, both PSPW index and MNBI were lower in Group A (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001). A strong inverse linear correlation was found between bile reflux and both MNBI (Pearson's test; <jats:italic>R<\/jats:italic>\u00a0=\u00a0\u22120.714; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001) and PSPW index (<jats:italic>R<\/jats:italic>\u00a0=\u00a0\u22120.722; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Inferences<\/jats:title><jats:p>Compared to acid reflux alone, the presence of bile in an acidic esophageal environment is associated with more severe heartburn, lesser relief from PPI therapy, higher impairment of esophageal mucosal integrity and less effective chemical clearance.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.13919","type":"journal-article","created":{"date-parts":[[2020,6,23]],"date-time":"2020-06-23T03:14:15Z","timestamp":1592882055000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Bile reflux in patients with nerd is associated with more severe heartburn and lower values of mean nocturnal baseline impedance and chemical clearance"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1995-1060","authenticated-orcid":false,"given":"Nicola","family":"de Bortoli","sequence":"first","affiliation":[{"name":"Gastroenterology Unit Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3388-0660","authenticated-orcid":false,"given":"C. 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Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7084-6157","authenticated-orcid":false,"given":"Leonardo","family":"Frazzoni","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences University of Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora","family":"Vichi","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierfrancesco","family":"Visaggi","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6387-6443","authenticated-orcid":false,"given":"Massimo","family":"Bellini","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4507-8605","authenticated-orcid":false,"given":"Elisa","family":"Marabotto","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit Department of Internal Medicine (DIMI) Universitry of Genoa Genoa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6918-9479","authenticated-orcid":false,"given":"Roberto","family":"Penagini","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology and Transplantation University of Milan Milan Italy"},{"name":"Fondazione 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