Acid and non-acid reflux in patients refractory to proton pump inhibitor therapy: Is gastroparesis a factor?

Tavakkoli, Anna; Sayed, Bisma Ali; Talley, Nicholas J.; Moshiree, Baharak

doi:10.3748/wjg.v19.i37.6193

Cited by 7 publications

(6 citation statements)

References 22 publications

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“…3 We observed a striking correlation between gastroparesis symptom severity and increasing taste alterations. In patients with bulimia, it has been suggested that frequent vomiting of at least 3 times per week chronically exposes taste receptors, specifically on the palate, to hydrochloric acid of the stomach, and alters the ability of patients to taste salt, sweet, bitter, and sour solutions.…”

Section: Discussionmentioning

confidence: 74%

“…GERD patients also suffer from numerous upper gastrointestinal (GI) symptoms including heartburn and regurgitation. 3 Patients with both gastroparesis and GERD are advised to manage symptoms by eating less fats and decreasing the frequency and size of meals. 4 From experience in practice, it has been observed that some patients with gastroparesis and with GERD attribute decreased enjoyment when eating to changes in taste and smell function.…”

Section: Introductionmentioning

confidence: 99%

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Taste and Smell Disturbances in Patients with Gastroparesis and Gastroesophageal Reflux Disease

Kabadi

Saadi

Schey

et al. 2017

J Neurogastroenterol Motil

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Background/AimsPatients with gastroparesis and gastroesophageal reflux disease (GERD) often report decreased enjoyment when eating. Some patients remark that food does not smell or taste the same. To determine if taste and/or smell disturbances are present in patients with gastroparesis and/or GERD and relate these to gastrointestinal symptom severity. MethodsPatients with gastroparesis and/or GERD completed questionnaires evaluating taste and smell (Taste and Smell Survey [TSS]), Patient Assessment of Upper Gastrointestinal Symptom Severity Index (PAGI-SYM), and Demographics. TSS questioned the nature of taste/ smell changes and the impact on quality of life. PAGI-SYM was used to calculate Gastroparesis Cardinal Symptom Index (GCSI) and Heartburn and Regurgitation Score (HB/RG). ResultsSeventy-six subjects were enrolled: healthy controls (n = 13), gastroparesis alone (n = 30), GERD alone (n = 10), and both gastroparesis and GERD (n = 23). Taste and smell disturbances were higher in patients with gastroparesis, GERD, and both gastroparesis and GERD compared to healthy controls. Taste and smell abnormalities were significantly correlated (r = 0.530, P < 0.001). Taste score was strongly correlated with HB/RG (r = 0.637, P < 0.001) and with GCSI (r = 0.536, P < 0.001). Smell score was also strongly correlated to HB/RG (r = 0.513, P < 0.001) and GCSI (r = 0.495, P < 0.001). ConclusionsTaste and smell abnormalities are prominent in gastroparesis and GERD patients. Abnormalities in taste and smell are significantly correlated with both gastroparesis and GERD symptom severity. Awareness of this high prevalence of taste and smell dysfunction among patients with gastroparesis and GERD may help to better understand the food intolerances these patients often have.

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Section: Discussionmentioning

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Taste and Smell Disturbances in Patients with Gastroparesis and Gastroesophageal Reflux Disease

Kabadi

Saadi

Schey

et al. 2017

J Neurogastroenterol Motil

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“…One study of 66 patients with refractory GERD who underwent gastric emptying studies found no statistical difference between patients with gastro-paresis and controls with respect to total number or duration of acid and nonacid reflux events. 71 However, a smaller study found that after 8 weeks of PPI treatment, patients with persistent symptoms and EE had more abnormal gastric emptying as compared to patients with persistent EE but no symptoms. 72 A possible association between gastric emptying and refractory GERD was also demonstrated in a small study in which 88% of patients who experienced improvement in gastroparesis symptoms also reported reduced GERD symptoms.…”

Section: Causes Of Refractory Gerdmentioning

confidence: 95%

Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutions

Mermelstein¹,

Mermelstein²,

Chait³

2018

CEG

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A significant percentage of patients with gastroesophageal reflux disease (GERD) will not respond to proton pump inhibitor (PPI) therapy. The causes of PPI-refractory GERD are numerous and diverse, and include adherence, persistent acid, functional disorders, nonacid reflux, and PPI bioavailability. The evaluation should start with a symptom assessment and may progress to imaging, endoscopy, and monitoring of esophageal pH, impedance, and bilirubin. There are a variety of pharmacologic and procedural interventions that should be selected based on the underlying mechanism of PPI failure. Pharmacologic treatments can include antacids, prokinetics, alginates, bile acid binders, reflux inhibitors, and antidepressants. Procedural options include laparoscopic fundoplication and LINX as well as endoscopic procedures, such as transoral incisionless fundoplication and Stretta. Several alternative and complementary treatments of possible benefit also exist.

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“…A recent study tried to determine whether an increased number and duration of non-acid reflux events—as measured using the multichannel intraluminal impedance pH (MII-pH)—were linked to GP and found no association between GP and more frequent episodes of non-acid reflux. 8 In contrast, a different study comparing MII-pH measures in patients with and without delayed GE found that patients with delayed GE were more likely to have increased total weakly acidic reflux and prolonged bolus clearance time but similar %pH <4. 24 Forty-three per cent of our patients with delayed GE had abnormal oesophageal acid exposure compared with 38% of our patients with normal GE, and both groups had similar magnitude of pathological acid reflux ( table 1 ).…”

Section: Discussionmentioning

confidence: 94%

Patients with symptoms of delayed gastric emptying have a high prevalence of oesophageal dysmotility, irrespective of scintigraphic evidence of gastroparesis

Triadafilopoulos

Nguyen

Clarke

2017

BMJ Open Gastroenterol

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BackgroundPatients with symptoms suggestive of gastroparesis exhibit several symptoms, such as epigastric pain, postprandial fullness, bloating and regurgitation. It is uncertain if such symptoms reflect underlying oesophageal motor disorder.AimsTo examine whether patients with epigastric pain and postprandial distress syndrome suggestive of functional dyspepsia and/or gastroparesis also have concomitant oesophageal motility abnormalities and, if so, whether there are any associations between these disturbances.MethodsIn this retrospective cohort study, consecutive patients with functional gastrointestinal symptoms suggestive of gastric neuromuscular dysfunction (gastroparesis or functional dyspepsia) underwent clinical assessment, gastric scintigraphy, oesophageal high-resolution manometry and ambulatory pH monitoring using standard protocols.ResultsWe studied 61 patients with various functional upper gastrointestinal symptoms who underwent gastric scintigraphy, oesophageal high-resolution manometry and ambulatory pH monitoring. Forty-four patients exhibited gastroparesis by gastric scintigraphy. Oesophageal motility disorders were found in 68% and 42% of patients with or without scintigraphic evidence of gastroparesis respectively, suggesting of overlapping gastric and oesophageal neuromuscular disorder. Forty-three per cent of patients with gastroparesis had abnormal oesophageal acid exposure with mean % pH <4.0 of 7.5 in contrast to 38% of those symptomatic controls with normal gastric emptying, with mean %pH <4.0 of 5.4 (NS). Symptoms of epigastric pain, heartburn/regurgitation, bloating, nausea, vomiting, dysphagia, belching and weight loss could not distinguish patients with or without gastroparesis, although weight loss was significantly more prevalent and severe (p<0.002) in patients with gastroparesis. There was no relationship between oesophageal symptoms and motor or pH abnormalities in either groups.ConclusionsIrrespective of gastric emptying delay by scintigraphy, patients with symptoms suggestive of gastric neuromuscular dysfunction have a high prevalence of oesophageal motor disorder and pathological oesophageal acid exposure that may contribute to their symptoms and may require therapy. High-resolution oesophageal manometry and pH monitoring are non-invasive and potentially useful in the assessment and management of these patients.

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Acid and non-acid reflux in patients refractory to proton pump inhibitor therapy: Is gastroparesis a factor?

Abstract: The evaluation of patients with a documented history of GP did not show an association between GP and more frequent episodes of non-acid reflux based on MII-pH testing.

Cited by 7 publications

References 22 publications

Taste and Smell Disturbances in Patients with Gastroparesis and Gastroesophageal Reflux Disease

Taste and Smell Disturbances in Patients with Gastroparesis and Gastroesophageal Reflux Disease

Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutions

Patients with symptoms of delayed gastric emptying have a high prevalence of oesophageal dysmotility, irrespective of scintigraphic evidence of gastroparesis

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