Proton Pump Inhibitor–Unresponsive Gastroesophageal Reflux Disease: A Prospective Cohort Study to Uncover Motility Disorder Masquerade
Abstract
A significant proportion of patients with gastroesophageal reflux disease (GERD) remain symptomatic despite adequate proton pump inhibitor (PPI) therapy, constituting PPI-unresponsive GERD. Esophageal motility abnormalities are increasingly recognized as contributors to symptom persistence. High-resolution manometry (HRM) interpreted using Chicago Classification version 4.0 (CCv4.0) provides improved diagnostic precision and clinical relevance.
The aim of this study was to evaluate esophageal motility patterns in patients with PPI-unresponsive GERD using HRM interpreted according to CCv4.0.
Adult patients with persistent GERD symptoms despite at least 8 weeks of PPI therapy underwent HRM using a solid-state catheter system. Studies were analyzed strictly according to CCv4.0 criteria. Demographic data, HRM findings, and pathological acid exposure were analyzed.
A total of 201 patients were included (mean age 62.7 ± 7.6 years; 17.4% male). Esophageal motility abnormalities were identified in 55%–65% of patients. Minor motility disorders predominated, with ineffective esophageal motility in 30%–35%. Major motility disorders were present in 10%–15%. Application of CCv4.0 led to diagnostic reclassification in 20%–25%. Pathological acid exposure was observed in 23.4%, whereas 76.6% had normal acid exposure despite persistent symptoms.
Esophageal motility abnormalities are common in PPI-unresponsive GERD. HRM interpreted using CCv4.0 enhances diagnostic accuracy and supports…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 201 participants or records.
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