***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction : More than half the patients with gastroesophageal reflux disease ( GERD ) show no endoscopic abnormality or minimal change esophagitis ( non-erosive reflux disease , NERD ) . We investigated the value of endoscopic and histological markers for the prediction of NERD before and after treatment with 20 mg esomeprazole . Methods : Between July and October 2002 , consecutive patients presenting for upper endoscopy were stratified into GERD and non-reflux patients ( control group )  with the help of a question naire . The endoscopist was blind to the presence of reflux symptoms . Using magnifying endoscopes minimal change esophagitis was defined by the presence of vascular injection or vascular spots above the Z-line , villous mucosal surface and isl and s of squamous cell epithelium below the Z-line . Targeted and r and om biopsies were taken below and above the Z-line . Patients with endoscopically visible classical signs of esophagitis ( Los Angeles A – D ) or histologically proven Barrett ’s esophagus were not further investigated in the study ( drop out ) . The esophageal specimens were histologically evaluated for erosions , infiltration with leukocytes , hyperplasia of basal cells and length of papillae . Patients with NERD were treated with 20 mg esomeprazole/day for 4 weeks and reevaluated by endoscopy as described before . Results : 39 patients with heartburn and 39 patients without reflux symptoms ( controls ) were finally included in the analysis ( per protocol ) . Patients with NERD significantly ( p = 0.005 ) more often showed endoscopic signs of minimal change esophagitis ( 27/39 ) than the control group ( 8/39 ) . An increased length of papillae ( 14/39 versus 2/39 ; p = 0.005 ) and basal cell hyperplasia ( 17/39 versus 4/39 ; p = 0.009 ) were significantly more common in the heartburn group . After treatment with esomeprazole , no significant endoscopic or histological differences between the NERD and control group could be observed . Conclusions : Minimal change esophagitis can be seen with high resolution magnifying endoscopy . By combining endoscopic and histological markers NERD can be predicted with a sensitivity of 62 % and a specificity of 74 % . Treatment with esomeprazole for 4 weeks reverses the slight alterations to normal Introduction : Irritable bowel syndrome ( IBS ) and functional dyspepsia ( FD ) are highly prevalent in the general population as does gastroesophageal reflux disease ( GERD ) . Therefore , it is expected that these conditions may frequently overlap . Objective : We aim ed at evaluating the presence ofFD and IBS symptoms in patients with erosive ( ERD ) , non-erosive reflux disease ( NERD ) and Barrett ’s esophagus ( BE ) . Patients and Methods : 71 patients presenting at the reflux disease outpatient clinic were prospect ively included in this study . 33 patients had NERD , 25 ERD and 13 BE according to the Montreal classification . All patients with ERD and NERD had typical reflux symptoms , as assessed by a vali date d GERD question naire ( RDQ ) . The diagnosis of functional dyspepsia and IBS symptoms was assessed according to the Rome III criteria . Results : IBS symptoms ( bloating , abdominal pain , constipation and diarrhea ) were slightly more prevalent in NERD ( 54.6 , 63.6 , 21.20 , 24.2 % , respectively ) than in ERD ( 48.0 , 44.0 , 12.0 , 20.0 % , respectively ) and in BE ( 53.9 , 23.10 , 15,4 , 23.1 % , respectively ) , but none of these differences reached statistical significance . NERD patients had more FD symptoms than patients with ERD or BE , but again this difference did not reach statistical significance . Conclusion : Our data show that IBS and FD are common in the entire spectrum of GERD . The presence of these disorders might explain why many patients with GERD are deemed as treatment failures if they have no complete symptom relief with proton pump inhibitors OBJECTIVES /HYPOTHESIS Laryngitis secondary to gastric acid reflux is a prevalent , yet incompletely understood , otolaryngological disorder . Further characterization of the relationship between symptoms and signs and reflux severity is needed . STUDY DESIGN Prospect i ve clinical trial . METHODS Forty-two consecutive , nonsmoking patients with one or more reflux laryngitis symptoms were recruited to complete a symptom question naire , videostrobolaryngoscopy , and 24-hour , dual-sensor pH probe testing .  Twenty-nine patients had more than four episodes of laryngopharyngeal reflux , and the remaining 13 served as control subjects .  Symptom scores were produced by multiplying the severity by the frequency for the following : hoarseness , throat pain , " lump-in-throat " sensation , throat clearing , cough , excessive phlegm , dysphagia , odynophagia , and heartburn . Endoscopic laryngeal signs included erythema and edema of the vocal folds and arytenoids , and interarytenoid irregularity . RESULTS Symptom scores varied significantly , with throat clearing being greater than the rest . None of the symptoms , except heartburn , correlated with reflux ( laryngopharyngeal and esophageal ) severity . Patients with worse laryngopharyngeal reflux were found to have worse esophageal reflux . Endoscopic laryngeal signs were rated as mild , on average , and did not correlate with laryngopharyngeal reflux severity . The number of laryngopharyngeal reflux episodes ( per 24 h ) ranged from 0 to 40 ( mean number , 10.6 episodes ) . CONCLUSIONS Throat clearing was the most intense symptom in the present group of patients with proven reflux laryngitis . Dual-sensor pH probe testing could not predict the severity of patient 's reflux laryngitis symptoms or signs . Only the heartburn symptom correlated with laryngopharyngeal and esophageal reflux OBJECTIVE : Previous uncontrolled studies suggested a therapeutic benefit for treating gastroesophageal reflux disease ( GERD ) among patients with laryngitis . The present study is the first r and omized , placebo-controlled , double-blind study of gastric acid suppression among patients with laryngitis in the United States . METHODS : Patients diagnosed with idiopathic chronic laryngitis were r and omized to receive either lansoprazole 30 mg p.o . b.i.d . or a matching placebo for 3 months . Before r and omization , all patients underwent upper endoscopy , dual probe ambulatory 24-h esophageal pH-metry , and laryngoscopy , as well as completing a symptom question naire for GERD and laryngitis . The primary outcome of treatment was the complete resolution of laryngeal symptoms . RESULTS : A total of 22 patients with symptoms and signs of chronic laryngitis were enrolled , 20 of whom completed the study . At baseline , there were no significant differences between the two groups with regards to GERD symptoms , erosive esophagitis , proximal and distal esophageal pH-metry , or laryngeal signs and symptoms . In an intention-to-treat analysis , six patients in the lansoprazole group ( 50 % ) and only one patient ( 10 % ) in the placebo group achieved a complete symptomatic response , p = 0.04 . Apart from receiving lansoprazole , there were no significant differences between responders and nonresponders in any of baseline esophageal or laryngeal signs and symptoms . CONCLUSIONS : Empirical treatment with lansoprazole is efficacious in relieving symptoms of laryngitis compared to placebo . Such treatment can be considered as a first-line option in managing patients with idiopathic chronic laryngitis Objective : Recent studies suggest an association between chronic cough and gastroesophageal reflux . Our study aims were 1 ) to define the prevalence of acid reflux induced cough in the general community , 2 ) to examine the ability of esophageal testing to identify gastroesophageal reflux related cough , and 3 ) to assess the utility of omeprazole in a chronic cough algorithm . Methods : Patients with chronic cough of unknown etiology , who were mostly from the community , were evaluated . Subjects underwent a chest x-ray , methacholine challenge test , and empiric trial of postnasal drip therapy , and completed daily cough symptom diaries subjectively evaluating cough frequency and severity on a grade d scale of 0–4 ( combined maximum 8) . After excluding other causes of cough , the remaining patients underwent esophageal and pH testing . Those testing positive were r and omized to omeprazole 40 mg b.i.d . or placebo for 12 weeks . Follow-up was 1 yr . Results : A total of 71 patients were screened ; 48 were excluded . Twenty-three patients were evaluated for gastroesophageal reflux disease ; six ( 26 % ) were eventually determined to have an acid-related cough . Of these patients , 17 had a positive pH test , six ( 35 % ) of whom showed a striking improvement or resolution of their cough during omeprazole treatment which was sustained for up to 1 yr . Six had a negative pH test , none of whom responded to omeprazole therapy . No significant differences were seen between responders ( n = 6 ) and nonresponders ( n = 11 ) for demographic factors , baseline symptom frequency and duration , or physiological parameters ( motility/pH ) . Conclusions : Acid-related chronic cough was present in 26 % ( six of 23 ) of patients evaluated for gastroesophageal reflux disease . Esophageal testing does not reliably identify patients with acid induced chronic cough responsive to proton pump inhibitor therapy . We suggest that the best diagnostic and therapeutic approach , after excluding asthma and postnasal drip syndrome , is empiric treatment for 2 wk with a high dose proton pump inhibitor The hypothesis that non-erosive reflux disease ( NERD ) patients comprise various subgroups is gaining popularity . This study was conducted to investigate the possibility of categorizing NERD patients according to symptom types and response to acid-suppressive drug rabeprazole ( RPZ ) 10 mg/day . NERD patients were classified as grade N ( endoscopically normal ) , M ( minimal change ) , or erosive GERD , and answered a 51-item , yes-or-no question naire pre and post-treatment . Compared to erosive GERD , clear differences existed in pretreatment prevalence of symptoms and responsiveness to RPZ in grade s N and M ; the results suggested stomachaches ( especially at night ) were significant symptoms in grade N and dysmotility-like symptoms like bloated stomach were significant in grade M while gastroesophageal reflux symptoms were significant in erosive GERD . Clinical significance of classifying NERD was indicated from different symptoms and responsiveness to PPI Aim : To determine whether symptomatic response to lansoprazole  predicts abnormal acid reflux in endoscopy‐negative patients with non‐cardiac chest pain Background Persistent gastro‐oesophageal reflux disease ( GERD ) , despite proton pump inhibitor ( PPI ) therapy , is a common problem . Combined pH/impedance monitoring ( pH/MII ) enables detection of reflux episodes Abstract Objectives . Data supporting the use of the proton pump inhibitor ( PPI ) test as a diagnostic test of gastroesophageal reflux disease ( GERD ) in Asia are lacking . The aims of this study were to evaluate the diagnostic characteristics of the PPI test and factors associated with responsiveness to PPIs . Methods . The PPI test was evaluated using lansoprazole ( 30 mg bid ) for two weeks . All patients underwent endoscopy after  symptom assessment . Patients without erosive esophagitis ( ERD ) underwent 48 h esophageal Bravo pH monitoring . Subjects were considered to be responsive to PPIs if they reported a > 50 % reduction in reflux symptom score . Results . Seventy-three patients ( M : F = 40:37 , 47 ± 13 years ) were enrolled . We identified 46 patients with ERD , 18 patients with nonerosive reflux disease ( NERD ) and 9 patients without GERD .  The PPI response rate was higher in patients with GERD than in patients without GERD ( 49/64 , 77 % vs. 4/9 , 44 % ; p < 0.05 ) . The sensitivity , specificity , and positive and negative predictive values were 77 % , 56 % , 92 % and 25 % , respectively . The PPI responsiveness was 80 % ( 37/46 ) in the ERD group and 67 % ( 12/18 ) in the NERD group . PPI response was not affected by age , sex , Helicobacter pylori , the psychological characteristics or cytochrome P2C genotypes . ERD and symptom-reflux association were the factors affecting PPI responsiveness . Conclusions . The PPI test was mod 
    Output:
    
That is , the PPI test has been proven to be a sensitive tool for diagnosing GERD  in patients with non-cardiac chest pain and in some preliminary trials regarding extraesophageal manifestations of GERD .
Ambulatory pH monitoring  of the esophagus helps to confirm gastroesophageal reflux in patients with persistent symptoms ( both typical and atypical ) in the absence of esophageal mucosal damage , especially when a trial of acid suppression has failed .
Impedance pH test  is useful in refractory reflux patients with primary complaints of typical  GERD  symptoms , but this value has not been proved in patients with non-cardiac chest pain or extraesophageal symptoms .