In patients with proton pump inhibitor-resistant non erosive reflux disease (NERD) having symptoms associated with liquid reflux, there are reports that reflux symptoms are more likely to be caused by the proximal extent of the reflux and reflux where pH <5. The objective of this study was to investigate the relationships between symptoms, reflux pH values, and the extent of reflux in patients with potassium-competitive acid blocker (P-CAB)-resistant NERD. Methods The subjects were 20 patients with P-CAB-resistant NERD whose symptoms did not improve even after administration of P-CAB (vonoprazan 20 mg/day) for 2–4 weeks. Their symptom index was positive for liquid reflux in impedance–pH monitoring. We investigated reflux pH values in symptomatic and asymptomatic reflux events, proportion of symptomatic reflux events according to the reflux pH value (pH <5 or ≥ 5), proportion of symptomatic reflux events at each impedance site, and proportion of symptomatic reflux events at each impedance site according to the reflux pH value (pH <5 or ≥ 5). Results About 60% of the symptomatic reflux events were caused by reflux with pH ≥5 in patients with P-CAB-resistant NERD. The median reflux pH value for total reflux events was 5.3 and that for symptomatic reflux events was 5.2. The proportion of symptomatic reflux events caused by reflux with pH <5 was significantly higher than that caused by reflux with pH ≥5. Symptomatic reflux events for reflux with pH <5 are more likely to be caused by proximal extent. There was no difference in the proportion of symptomatic reflux events for reflux with pH ≥5 at each reflux extent site. Conclusion In patients with P-CAB-resistant NERD, their symptoms were often caused by reflux with pH ≥5. A difference in the relationship between the reflux extent site and appearance of symptoms was observed according to the reflux pH value.

中文翻译：

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169 抗 P-CAB NERD 患者的症状、反流 PH 值和反流程度之间的关系

在具有与液体反流相关症状的质子泵抑制剂耐药的非糜烂性反流病 (NERD) 患者中，有报道称反流症状更可能由反流的近端范围和 pH <5 的反流引起。本研究的目的是调查对钾竞争性酸阻滞剂 (P-CAB) 耐药的 NERD 患者的症状、反流 pH 值和反流程度之间的关系。方法 受试者为 20 名 P-CAB 耐药 NERD 患者，即使在给予 P-CAB（沃诺拉赞 20 mg/天）2-4 周后症状也没有改善。在阻抗-pH 监测中，他们的症状指数对液体回流呈阳性。我们调查了有症状和无症状反流事件中的反流 pH 值，根据反流 pH 值（pH <5 或 ≥ 5）的症状性反流事件的比例，每个阻抗部位的症状性反流事件的比例，以及根据反流 pH 值的每个阻抗部位的症状性反流事件的比例（pH <5 ;5 或 ≥ 5)。结果 P-CAB 耐药 NERD 患者中约 60% 的症状性反流事件是由 pH ≥5 的反流引起的。总反流事件的中位反流 pH 值为 5.3，症状性反流事件的中位反流 pH 值为 5.2。由pH <5的反流引起的症状性反流事件的比例显着高于由pH≥5引起的反流。pH <5 的反流症状性反流事件更可能是由近端范围引起的。在每个反流程度部位，对于 pH ≥ 5 的反流，症状性反流事件的比例没有差异。结论 P-CAB耐药NERD患者的症状多为pH≥5的反流所致。根据返流pH值观察返流程度部位与症状出现的关系存在差异。