{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T21:29:13Z","timestamp":1767907753250,"version":"3.49.0"},"reference-count":0,"publisher":"S. Karger AG","issue":"4","license":[{"start":{"date-parts":[[2019,7,29]],"date-time":"2019-07-29T00:00:00Z","timestamp":1564358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2019,7,29]],"date-time":"2019-07-29T00:00:00Z","timestamp":1564358400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Digestion"],"published-print":{"date-parts":[[2020]]},"abstract":"<jats:p>Background and Objectives: Weakly acidic reflux has been reported as the major cause of symptom occurrence in patients with proton pump inhibitor (PPI)-refractory non-erosive reflux disease (NERD). This study is aimed at clarifying whether the pH value of weakly acidic reflux affects the induction of symptoms. Methods: We retrospectively evaluated the records of combined multichannel intraluminal impedance and pH monitoring in 57 patients with PPI-refractory NERD. Weakly acidic refluxes were divided into 3 categories based on the pH value of the refluxate: pH 4\u20135, 5\u20136, and 6\u20137. Results: A total of 29 patients were positive in the symptom index. The symptom provocation rate in reflux of pH 4\u20135 (19%) was much higher than in that of pH 5\u20136 (11%) and pH 6\u20137 (12%). In the reflux at pH 4\u20135, the symptom provocation rate in the proximal reflux was higher than that in the distal reflux (p &lt; 0.05), whereas the reflux at pH 5\u20136 and pH 6\u20137 was not significantly different in the symptom provocation rate between the proximal and distal refluxes. Conclusion: Reflux at pH &lt;5 reaching the proximal esophagus was the main factor in the induced symptoms of patients with PPI-refractory NERD.<\/jats:p>","DOI":"10.1159\/000500133","type":"journal-article","created":{"date-parts":[[2019,7,29]],"date-time":"2019-07-29T21:00:29Z","timestamp":1564434029000},"page":"375-381","source":"Crossref","is-referenced-by-count":7,"title":["Influence of the pH Value of Refluxate and Proximal Extent on Heartburn Perception in Patients with Proton Pump Inhibitor-Refractory Non-Erosive Reflux Disease"],"prefix":"10.1159","volume":"101","author":[{"given":"Yasuaki","family":"Abe","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6472-3257","authenticated-orcid":false,"given":"Tomoyuki","family":"Koike","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiro","family":"Saito","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoki","family":"Okata","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuaki","family":"Norita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroki","family":"Kikuchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenichiro","family":"Nakagawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Waku","family":"Hatta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiyotaka","family":"Asanuma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaname","family":"Uno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoki","family":"Asano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akira","family":"Imatani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tooru","family":"Shimosegawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsushi","family":"Masamune","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"127","published-online":{"date-parts":[[2019,7,29]]},"container-title":["Digestion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/dig\/article-pdf\/101\/4\/375\/4027915\/000500133.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/karger.com\/dig\/article-pdf\/101\/4\/375\/4027915\/000500133.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T16:34:55Z","timestamp":1745426095000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000500133"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,29]]},"references-count":0,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,7,3]]},"published-print":{"date-parts":[[2020,7,7]]}},"URL":"https:\/\/doi.org\/10.1159\/000500133","archive":["Portico"],"relation":{},"ISSN":["0012-2823","1421-9867"],"issn-type":[{"value":"0012-2823","type":"print"},{"value":"1421-9867","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,7,29]]}}}