Impedance-pH reflux patterns can differentiate non-erosive reflux disease from functional heartburn patients

Edoardo Savarino, Patrizia Zentilin, Radu Tutuian, Daniel Pohl, Lorenzo Gemignani, Alberto Malesci, Vincenzo Savarino

Research output: Contribution to journalArticlepeer-review


Introduction Symptom association is important to distinguish non-erosive reflux disease [NERD; abnormal oesophageal acid exposure time (AET) and/or positive symptom association] from functional heartburn (FH; normal AET and negative symptom association). Asymptomatic patients during reflux monitoring are challenging as symptom association cannot be assessed. Aim To evaluate whether impedance-pH reflux patterns are useful to differentiate NERD from FH. Methods Endoscopy-negative reflux patients underwent impedance-pH off-therapy. Oesophageal AET, characteristics of reflux episodes and symptom association probability (SAP) were measured. Twenty patients asymptomatic during the first test repeated a second examination. Results Of 329 patients, 130 (40%) were pH-POS, 120 (36%) pH-NEG/SAP? (hypersensitive oesophagus - HO) and 79 (24%) pH-NEG/SAP - (FH). Total and acid reflux episodes were significantly higher (p <0.01) in pH-POS compared to pH-NEG/SAP?, pH-NEG/SAP - and healthy volunteers (HVs). Patients pH-NEG/SAP? had a significantly increased number of weakly acidic reflux episodes compared to pH-POS, pH-NEG/SAP - and HVs (p <0.01). The rate of proximal reflux episodes in pH-POS (50%) and pH-NEG/SAP? (47%) was higher (p <0.01) than in pH-NEG/SAP - (33%) and HVs (33%). Measuring AET, number of reflux episodes and percentage of proximal reflux events permits to identify FH in 70% of cases and HO in 80% of cases who repeated the examination. Conclusion In patients with normal AET and SAP?, increased number of weakly acidic reflux and higher rate of proximal reflux are the main discriminant features. There is large overlap between FH and HVs. These differences can be of help in diagnosing patients with normal oesophageal acid exposure who fail to have symptoms during MII-pH testing.

Original languageEnglish
Pages (from-to)159-168
Number of pages10
JournalJournal of Gastroenterology
Issue number2
Publication statusPublished - Feb 2012


  • Functional heartburn
  • Hypersensitive oesophagus
  • Impedance pH-metry
  • NERD

ASJC Scopus subject areas

  • Gastroenterology


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