Journal of gastroenterology · 2025
Associations between excessive supragastric belching and esophageal reflux factors in patients with PPI-refractory GERD in Japan.
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Shuto Yukihiro, Saito Masahiro, Koike Tomoyuki, Koizumi Kaoru, Kaise Yumiko, Yachi Kazuma, Hatayama Yutaka, Ogata Yohei, Jin Xiaoyi, Kanno Takeshi, Hatta Waku, Uno Kaname, Asano Naoki, Imatani Akira, Masamune Atsushi
Аннотация
BACKGROUND: No studies have evaluated the prevalence of supragastric belching (SGB) in Japanese patients with proton pump inhibitor (PPI)-refractory non-erosive reflux disease (NERD) under off-PPI conditions. This study aimed to clarify the association between excessive SGB and esophageal reflux factors.
METHODS: Seventy-nine patients with PPI-refractory NERD under off-PPI treatment were evaluated using 24-h multichannel intraluminal impedance pH monitoring and high-resolution impedance manometry.
RESULTS: The prevalence values of excessive SGB overall and in the true NERD, reflux hypersensitivity, and function heartburn subtypes were 19.0%, 35.7%, 5.3%, and 12.5%, respectively. The monitoring results demonstrated that, compared with those without excessive SGB, patients with excessive SGB had a significantly higher total number of reflux events (63 episodes vs. 39 episodes, p = 0.01) and significantly greater acid exposure time (6.1% vs. 1.35%, p = 0.01). However, bolus exposure did not differ significantly between the groups (p = 0.09). The manometry findings showed no significant differences in lower esophageal sphincter pressure, integrated relaxation pressure, and distal contractile integral between the groups. Regarding gastroesophageal reflux, 22% of the SGB episodes were preceded by reflux, 55% occurred independently, and 23% were followed by reflux.
CONCLUSIONS: The prevalence of excessive SGB in Japanese patients with PPI-refractory NERD under off-PPI conditions was 19.0% and most commonly observed in patients with true NERD (35.7%). Patients with excessive SGB exhibited increased esophageal acid exposure, and reflux events were sometimes observed before SGB episodes.
METHODS: Seventy-nine patients with PPI-refractory NERD under off-PPI treatment were evaluated using 24-h multichannel intraluminal impedance pH monitoring and high-resolution impedance manometry.
RESULTS: The prevalence values of excessive SGB overall and in the true NERD, reflux hypersensitivity, and function heartburn subtypes were 19.0%, 35.7%, 5.3%, and 12.5%, respectively. The monitoring results demonstrated that, compared with those without excessive SGB, patients with excessive SGB had a significantly higher total number of reflux events (63 episodes vs. 39 episodes, p = 0.01) and significantly greater acid exposure time (6.1% vs. 1.35%, p = 0.01). However, bolus exposure did not differ significantly between the groups (p = 0.09). The manometry findings showed no significant differences in lower esophageal sphincter pressure, integrated relaxation pressure, and distal contractile integral between the groups. Regarding gastroesophageal reflux, 22% of the SGB episodes were preceded by reflux, 55% occurred independently, and 23% were followed by reflux.
CONCLUSIONS: The prevalence of excessive SGB in Japanese patients with PPI-refractory NERD under off-PPI conditions was 19.0% and most commonly observed in patients with true NERD (35.7%). Patients with excessive SGB exhibited increased esophageal acid exposure, and reflux events were sometimes observed before SGB episodes.