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Non-acid Reflux: When It Matters and Approach to Management

Authors
  • Zikos, Thomas A.1
  • Clarke, John O.1
  • 1 Stanford University School of Medicine, 430 Broadway Street, Pavilion C, 3rd Floor, GI suite, Redwood City, CA, 94063, USA , Redwood City (United States)
Type
Published Article
Journal
Current Gastroenterology Reports
Publisher
Springer US
Publication Date
Jul 10, 2020
Volume
22
Issue
9
Identifiers
DOI: 10.1007/s11894-020-00780-4
Source
Springer Nature
Keywords
License
Yellow

Abstract

Purpose of ReviewThis narrative review focuses on the presentation, contributing factors, diagnosis, and treatment of non-acid reflux. We also propose algorithms for diagnosis and treatment.Recent FindingsThere is a paucity of recent data regarding non-acid reflux. The recent Porto and Lyon consensus statements do not fully address non-acid reflux or give guidance on classification. However, recent developments in the lung transplantation field, as well as older data in the general population, argue for the importance of non-acid reflux.SummaryExtrapolating from the Porto and Lyon consensus, we generally classify pathologic non-acid reflux as impedance events > 80, acid exposure time < 4%, and positive symptom correlation on a standard 24-h pH/impedance test. Other groups not meeting this criteria also deserve consideration depending on the clinical situation. Potential treatments include lifestyle modification, increased acid suppression, alginates, treatment of esophageal hypersensitivity, baclofen, buspirone, prokinetics, and anti-reflux surgery in highly selected individuals. More research is needed to clarify appropriate classification, with subsequent focus on targeted treatments.

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