Weakly acidic reflux

The advent of pH impedance monitoring has allowed assessment of the role of weakly acidic reflux, in addition to the traditionally considered acid reflux, in the pathophysiology of gastroesophageal reflux disease. Typical reflux symptoms studied off proton pump inhibitor (PPI) therapy are mainly associated with acid reflux events, while weakly acidic reflux is only significantly associated with symptom occurrence when assessed on PPI therapy. A major role in weakly acidic reflux in the absence of acid suppressive therapy has only been established for reflux-related cough. Further studies are needed to address the impact of weakly acidic reflux on the management and therapeutic choices in gastroesophageal reflux disease patients with symptoms that persist on PPI therapy. There is a lack of outcomes studies addressing the issue of reflux inhibitors and surgery for weakly acidic reflux that persists in patients on PPIs.