Increased Prandial Air Swallowing and Postprandial Gas-Liquid Reflux Among Patients Refractory to Proton Pump Inhibitor Therapy  Ivana Bravi, Philip Woodland, Ravinder S. Gill, Mohannad Al–Zinaty, Albert J. Bredenoord, Daniel Sifrim  Clinical Gastroenterology and Hepatology  Volume 11, Issue 7, Pages 784-789 (July 2013) DOI: 10.1016/j.cgh.2012.12.041 Copyright © 2013 AGA Institute Terms and Conditions

Figure 1 Mealtime air swallowing rate in PPI-responsive and PPI-refractory patients. Clinical Gastroenterology and Hepatology 2013 11, 784-789DOI: (10.1016/j.cgh.2012.12.041) Copyright © 2013 AGA Institute Terms and Conditions

Figure 2 A compressed 24-hour pH-impedance recording showing excessive air swallowing during the circled mealtimes. Clinical Gastroenterology and Hepatology 2013 11, 784-789DOI: (10.1016/j.cgh.2012.12.041) Copyright © 2013 AGA Institute Terms and Conditions

Figure 3 A suggested paradigm of refractoriness to PPI. Patients in group A have normal acid exposure and are asymptomatic. Patients in group B have high acid exposure (sensitized) but relatively little mixed reflux and remain responsive to PPI therapy. Patients in group C have high acid (sensitized) and high numbers of air swallow–induced mixed reflux, stimulating both chemosensitive and mechanosensitive nociceptors. Clinical Gastroenterology and Hepatology 2013 11, 784-789DOI: (10.1016/j.cgh.2012.12.041) Copyright © 2013 AGA Institute Terms and Conditions