Evidence map›Paper›PMID 16556669›Full record

ArticleGut2006

Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicentre study using combined ambulatory impedance-pH monitoring.

I Mainie, R Tutuian, S Shay, M Vela, X Zhang, D Sifrim, D O Castell

Registry-linked trialAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Gut, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03282084 (A Prospective, Observational Study of the PPI Non-responder), which is not on this map. Cited by 189 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
189citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03282084 withdrawnnot on this mapstarted 2017, after this paper: background citation

A Prospective, Observational Study of the PPI Non-responder

TypeobservationalSponsorDartmouth-Hitchcock Medical CenterRan2017 to 2018Enrolled0ConditionsGastro Esophageal Reflux Disease PPI Non-RespondersArmsEGD with biopsy, EGD and impedance-pH study on PPI
3 · Its place in the literature

Who cites it

189 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Guideline
  2. Guideline
  3. Patient satisfaction with medication for gastroesophageal reflux disease: a systematic review.Canadian journal of gastroenterology = Journal canadien de gastroenterologie · 2012
    Pooled it
  4. Trial
  5. Trial
  6. Trial
  7. Trial
  8. Trial
  9. Trial
  10. Article
  11. Smart Catheters for Diagnosis, Monitoring, and Therapy.Advanced healthcare materials · 2026
    Review
  12. Article
  13. Article
  14. Review
  15. Article
  16. Article
  17. Multichannel intraesophageal impedance with pH metry in Saudi children.Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association · 2024
    Article
  18. Article
  19. Article
  20. Article

129 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

I MainieDivision of Gastroenterology and Hepatology, Medical University South Carolina, 96 Jonathan Lucas St, 210 Clinical Science Building, PO Box 250327 Charleston, SC 29425, USA. mainie@musc.edu
R Tutuian
S Shay
M Vela
X Zhang
D Sifrim
D O Castell

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

aimsEmpiric proton pump inhibitor (PPI) trials have become increasingly popular leading to gastroenterologists frequently evaluating gastro-oesophageal reflux disease (GORD) patients only after they have "failed" PPI therapy. Combined multichannel intraluminal impedance and pH (MII-pH) monitoring has the ability to detect gastro-oesophageal reflux (GOR) episodes independent of their pH and evaluate the relationship between symptoms and all types of GOR. Using this technique, we aimed to characterise the frequency of acid and non-acid reflux (NAR) and their relationship to typical and atypical GOR symptoms in patients on PPI therapy.

methodsPatients with persistent GORD symptoms referred to three centres underwent 24 hour combined MII-pH monitoring while taking PPIs at least twice daily. Reflux episodes were detected by impedance channels located 3, 5, 7, 9, 15, and 17 cm above the lower oesophageal sphincter (LOS) and classified into acid or non-acid based on pH data from 5 cm above the LOS. A positive symptom index (SI) was declared if at least half of each specific symptom events were preceded by reflux episodes within five minutes.

resultsA total of 168 patients (103 (61%) females and 65 (39%) males; mean age 53 (range 18-85) years) underwent combined MII-pH monitoring while taking PPIs at least twice daily. One hundred and forty four (86%) patients recorded symptoms during the study day and 24 (15%) patients had no symptoms during testing. Sixty nine (48%) symptomatic patients had a positive SI for at least one symptom (16 (11%) with acid reflux and 53 (37%) with NAR) and 75 (52%) had a negative SI. A total of 171 (57%) typical GORD symptoms were recorded, 19 (11%) had a positive SI for acid reflux, 52 (31%) for NAR, and 100 (58%) had a negative SI. One hundred and thirty one (43%) atypical symptoms were recorded, four (3%) had a positive SI for acid reflux, 25 (19%) had a positive SI for NAR, and 102 (78%) had a negative SI.

conclusionCombined MII-pH identifies the relation of reflux of all types to persistent symptoms and the importance of NAR in patients taking PPIs.

Indexed as

AdolescentAdultAgedAged, 80 and overAmbulatory CareChronic DiseaseDrug ResistanceElectric ImpedanceFemaleGastric AcidGastric Acidity DeterminationGastroesophageal RefluxHumansHydrogen-Ion ConcentrationMaleMiddle AgedProton Pump Inhibitors

Identifiers

PMID16556669
PMCPMC1856433

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.