Excessive air swallowing linked to dyspepsia, poor response to PPI therapy

Swallowing more air appears to induce both dyspepsia and refractoriness to typical symptoms of gastroesophageal reflux disease (GERD) to proton pump inhibitor (PPI) therapy, suggests a study.

The authors retrospectively assessed multichannel intraluminal impedance-pH tracings from consecutive patients. They then evaluated GERD and concomitant functional dyspepsia (FD) symptoms using a validated structured questionnaire. All patients received treatment, within the previous year, of at least 8 weeks of standard-dose PPI therapy.

The analysis involved 35 patients with conclusive GERD, 35 with reflux hypersensitivity, and 35 with functional heartburn. The number of air swallows directly correlated with mixed refluxes (r=0.64). Receiver operating characteristic curve analysis revealed the significant association of air swallows and mixed refluxes with the presence of FD and PPI refractoriness.

An air swallow cutoff of 107 episodes/24 hours was set to distinguish patients with and without FD (sensitivity, 87 percent; specificity, 82.8 percent), while a mixed reflux cutoff of 34 episodes/24 hours was found to classify PPI responders from nonresponders (sensitivity, 84.8 percent, specificity, 69 percent).

Notably, multivariate analysis showed the significant association of an abnormal number of air swallows and of mixed refluxes with FD and PPI refractoriness.

“It has been shown that individuals with excessive air swallowing experience FD,” the authors said. “It has been also demonstrated that a consistent group of GERD patients not responding to PPI therapy swallow more air during mealtime and also have more mixed refluxes.”