{"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":1792301060432,"version":"4.4.0"},"reference-count":17,"publisher":"BMJ","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[2008,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background and aim:<\/jats:title>\n                    <jats:p>Approximately 20% of patients have persistent symptoms of gastro-oesophageal reflux despite proton pump inhibitor (PPI) therapy. The aim of this study was to assess the determinants of reflux perception in patients on PPI therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods:<\/jats:title>\n                    <jats:p>20 patients with typical gastro-oesophageal reflux symptoms (heartburn and\/or regurgitation) despite double-dose PPIs (twice daily) were included in this study. Ambulatory 24 h pH\u2013impedance studies were performed in all patients. The characteristics of symptomatic and asymptomatic reflux episodes were compared. Symptoms were considered globally and separately for heartburn and regurgitation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 1273 reflux episodes were detected including 243 (19.1%) acidic, 1018 (80.0%) weakly acidic and 12 (0.9%) weakly alkaline reflux episodes. Overall, 312 (24.5%) reflux episodes were symptomatic. The only factor associated with reflux perception was high proximal extent (p\u200a=\u200a0.037). Compared with regurgitation, reflux episodes associated with heartburn were more frequently pure liquid (p\u200a=\u200a0.009) and acidic (p\u200a=\u200a0.027), had a lower nadir pH (p&lt;0.001), were more frequently preceded by acid reflux episodes (p&lt;0.001) and had a longer reflux bolus clearance time (p&lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>High proximal extent of the refluxate is the only factor associated with reflux perception in patients on double-dose PPI. However, compared with regurgitation, composition of the refluxate, sensitisation of the oesophagus by preceding acid exposure and delayed bolus clearance appear to play a role in heartburn perception.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/gut.2007.133470","type":"journal-article","created":{"date-parts":[[2007,10,19]],"date-time":"2007-10-19T19:11:34Z","timestamp":1192821094000},"page":"156-160","source":"Crossref","is-referenced-by-count":145,"title":["Determinants of gastro-oesophageal reflux perception in patients with persistent symptoms despite proton pump 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values for ambulatory 24-h combined impedance\u2013pH monitoring on acid suppressive therapy.","volume":"130","author":"Tutuian","year":"2006","journal-title":"Gastroenterology"},{"key":"2025090711582370000_57.2.156.15","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1097\/00004836-199409000-00003","article-title":"24-hour pH monitoring in symptomatic patients without erosive esophagitis who did not respond to antireflux treatment.","volume":"19","author":"Fass","year":"1994","journal-title":"J Clin Gastroenterol"},{"key":"2025090711582370000_57.2.156.16","first-page":"2110","article-title":"Prolonged ambulatory pH monitoring in patients with persistent gastroesophageal reflux disease symptoms: testing while on therapy identifies the need for more aggressive anti-reflux therapy.","volume":"91","author":"Katzka","year":"1996","journal-title":"Am J 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