Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May;26(5-6):221-229.
doi: 10.1111/1751-2980.70007. Epub 2025 Sep 1.

Dynamic Relevance Between Reflux Events and Esophageal Motility in Patients With Proton Pump Inhibitor-Refractory Gastroesophageal Reflux Disease

Si Hui Lin  1   2 , Zhi Feng Wang  1 , Hua Li  2 , Xiao Hong Sun  1 , Xiao Qing Li  1 , Gui Jun Fei  1 , Wei Guang Chen  1 , Tao Guo  1 , Mei Yun Ke  1 , Xiu Cai Fang  1
Affiliations

Dynamic Relevance Between Reflux Events and Esophageal Motility in Patients With Proton Pump Inhibitor-Refractory Gastroesophageal Reflux Disease

Si Hui Lin et al. J Dig Dis. 2025 May.

Abstract

Objectives: The association between reflux events and esophageal motility abnormality is unclear. We aimed to determine the relevance between reflux events and esophageal motility in proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease (GERD).

Methods: Patients with PPI-refractory or PPI-responsive GERD were enrolled. Ambulatory 24-h esophageal pH-impedance-pressure monitoring was performed. Reflux symptoms, reflux events, and esophageal motility during acid reflux episodes were recorded and compared between the two groups.

Results: Sixty patients with PPI-refractory GERD and 18 with PPI-responsive GERD were included, all of whom had pathological gastroesophageal reflux. There were no significant differences in the major acid reflux parameters (DeMeester score and proportion of patients with acid exposure time > 6%) between the two groups. However, the number of long acid reflux episodes and the time length of the longest reflux episodes were significantly higher in the PPI-refractory GERD group than in the PPI-responsive GERD group (both p < 0.05). Moreover, patients with PPI-refractory GERD had higher rates of ineffective primary (62.0% vs. 36.0%, p < 0.001) and secondary peristalsis (83.5% vs. 57.0%, p = 0.001) during long acid exposure (LAE) than those with PPI-responsive GERD. Patients with PPI-refractory GERD having LAE had a significantly lower frequency of primary and secondary peristalsis per minute and required a longer time to initiate secondary peristalsis than those without during their longest acid reflux period in the upright position (all p < 0.001).

Conclusion: Longer acid reflux episodes in patients with PPI-refractory GERD might result from frequent ineffective primary esophageal peristalsis and delayed initiation of effective secondary peristalsis.

Keywords: acid reflux; esophageal motility disorders; esophageal pH monitoring; gastroesophageal reflux.

PubMed Disclaimer

Conflict of interest statement

Xiu Cai Fang and Mei Yun Ke are Editorial Board Members for Journal of Digestive Diseases but were not involved in the editorial review or the decision to publish this article. All authors declare that they have no competing interests.

References

    1. Dunbar K. B., “Gastroesophageal Reflux Disease,” Annals of Internal Medicine 177, no. 8 (2024): ITC113–ITC128. - PubMed
    1. Fock K. M., Talley N., Goh K. L., et al., “Asia‐Pacific Consensus on the Management of Gastro‐Oesophageal Reflux Disease: An Update Focusing on Refractory Reflux Disease and Barrett's Oesophagus,” Gut 65, no. 9 (2016): 1402–1415. - PubMed
    1. Desjardin M., Luc G., Collet D., and Zerbib F., “24‐Hour pH‐Impedance Monitoring on Therapy to Select Patients With Refractory Reflux Symptoms for Antireflux Surgery. A Single Center Retrospective Study,” Neurogastroenterology and Motility 28, no. 1 (2016): 146–152. - PubMed
    1. Katz P. O., Gerson L. B., and Vela M. F., “Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease,” American Journal of Gastroenterology 108, no. 3 (2013): 308–328. - PubMed
    1. Yadlapati R., Gyawali C. P., and Pandolfino J. E., “AGA Clinical Practice Update on the Personalized Approach to the Evaluation and Management of GERD: Expert Review,” Clinical Gastroenterology and Hepatology 20, no. 5 (2022): 984–994.e1. - PMC - PubMed

Substances