{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T07:35:18Z","timestamp":1768721718017,"version":"3.49.0"},"reference-count":21,"publisher":"S. Karger AG","issue":"1","license":[{"start":{"date-parts":[[2015,1,1]],"date-time":"2015-01-01T00:00:00Z","timestamp":1420070400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"},{"start":{"date-parts":[[2015,1,1]],"date-time":"2015-01-01T00:00:00Z","timestamp":1420070400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Digestion"],"published-print":{"date-parts":[[2015]]},"abstract":"<jats:p>&lt;b&gt;&lt;i&gt;Background:&lt;\/i&gt;&lt;\/b&gt; Patients with proton pump inhibitor (PPI)-resistant nonerosive reflux disease (NERD) include subgroups that have markedly different pathophysiology. This study aimed to clarify the pathophysiology of NERD by esophageal manometry with 24-hour esophageal impedance and pH monitoring. &lt;b&gt;&lt;i&gt;Methods:&lt;\/i&gt;&lt;\/b&gt; Eighteen consecutive outpatients referred to our expert center for functional gastrointestinal motility with suspected PPI-resistant NERD were enrolled. Manometry was performed to detect esophageal motility disorders. Subsequently, 24-hour esophageal impedance and pH monitoring was done while patients were on PPI therapy. &lt;b&gt;&lt;i&gt;Results:&lt;\/i&gt;&lt;\/b&gt; Manometry revealed 1 case of achalasia, 1 case of nutcracker esophagus and 3 cases of diffuse esophageal spasm. Three patients had ineffective esophageal motility, with impedance and pH monitoring being performed in 2 of them. Esophageal acid exposure (%time pH &lt;4) was normal in both, but the symptom index (SI) was positive for nonacidic reflux in 1 patient. One of the 10 patients with normal esophageal motility had abnormal esophageal acid exposure. The SI was positive for weakly acidic and nonacidic reflux in 3 of the remaining 9 patients with normal esophageal acid exposure. Five of the other 6 patients seemed to have functional heartburn. &lt;b&gt;&lt;i&gt;Conclusion:&lt;\/i&gt;&lt;\/b&gt; A substantial percentage (28%) of patients with suspected PPI-resistant NERD had primary esophageal motility disorders. Both nonacidic reflux and weakly acidic reflux are important contributors to the symptoms of patients with PPI-resistant NERD. Esophageal manometry is required to exclude motility disorders, while 24-hour esophageal impedance and pH monitoring is invaluable for assessing symptom-reflux associations and the indications for fundoplication in patients with suspected PPI-resistant NERD.<\/jats:p>","DOI":"10.1159\/000368766","type":"journal-article","created":{"date-parts":[[2015,1,19]],"date-time":"2015-01-19T15:42:40Z","timestamp":1421682160000},"page":"19-25","source":"Crossref","is-referenced-by-count":15,"title":["Evaluation of Proton Pump Inhibitor-Resistant Nonerosive Reflux Disease by Esophageal Manometry and 24-Hour Esophageal Impedance and pH Monitoring"],"prefix":"10.1159","volume":"91","author":[{"given":"Osamu","family":"Kawamura","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroko","family":"Hosaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuyuki","family":"Shimoyama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akiyo","family":"Kawada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiko","family":"Kuribayashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Motoyasu","family":"Kusano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masanobu","family":"Yamada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"127","published-online":{"date-parts":[[2015,1,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2006.00630.x"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1097\/01.mcg.0000225631.07039.6d"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1007\/s00535-009-0047-5"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1159\/000341421"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1159\/000331142"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1053\/gast.2001.24840"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2008.02119.x"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2005.087668"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.2009.01311.x"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1136\/gut.49.1.145"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1023\/A:1018802908358"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.2010.01658.x"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1007\/s00535-004-1417-7"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.1991.tb00061.x"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.1993.tb00114.x"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.3109\/00365529409092496"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2004.30349.x"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2008.02033.x"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2008.23"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2005.08.060"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1159\/000345144"}],"container-title":["Digestion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/368766","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/368766","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/368766","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T17:54:20Z","timestamp":1745430860000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000368766"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2015,1,1]]},"published-print":{"date-parts":[[2015,1,20]]}},"URL":"https:\/\/doi.org\/10.1159\/000368766","archive":["Portico"],"relation":{},"ISSN":["0012-2823","1421-9867"],"issn-type":[{"value":"0012-2823","type":"print"},{"value":"1421-9867","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015]]}}}