Isease, GERD ?gastroesophageal reflux disease, H.p. ?Helicobacter pylori, LA ?Los Angeles classification, PPI ?proton pump inhibitorbined pH and MII monitoring with additive prucalopride medication (2mg per day) showed a decrease of overall (n = 108) and non- and/or weakly acid reflux episodes (n = 76) and a slight improve of acid reflux episodes (from 15 to 32). Her SI was damaging for regurgitation but remained optimistic for heartburn. Her subjective symptom score for heartburn and regurgitation and her subjective score for the influence of these symptoms on her every day life have been each stated as a “5” by our patient.PatientThis 70-year-old Caucasian lady with chronic constipation reported possessing reflux symptoms (regurgitation) for much more than ten years. Medication with omeprazole 20mg every day did not result in any symptom relief. Gastroscopyshowed little axial herniation without erosive lesions towards the distal esophagus. In the course of the initial combined pH and MII-monitoring, her SI was positive for regurgitation and whereas pH monitoring showed standard findings, MII monitoring revealed elevated all round reflux episodes (n = 96) with foremost non- and/or weakly acid reflux episodes (n = 79). Her subjective symptom score for regurgitation was “5”. The subjective rating in the influence of regurgitation on her everyday life was also “5” on a 10-point scale. Prucalopride therapy led to a decrease of overall reflux episodes (n = 83), non- and/or weakly reflux episodes (n = 57).Formula of H-Lys(Aloc)-OH There was a slight raise of acid reflux episodes (from 17 to 26). Her subjective scores for symptoms and influence on every day life were both stated as “3”. SI for regurgitation was damaging.Table 2 Results of multichannel impedance-pH monitoring just before pucalopride treatmentPatient 1 Patient two Patient 3 Patient four MII-pH monitoring Medication during monitoring: Medication in the course of monitoring: Medication in the course of monitoring: Medication throughout monitoring: prior to remedy – Ranitidine 75mg each day – Pantoprazole 40mg each day – Omeprazole 20mg each day – none with prucalopride Acid reflux time: 1.five Acid reflux time: 0.three Acid reflux time: 0.1 Acid reflux time: two.8 Overall reflux episodes: Mixed or liquid reflux episodes: 128 94 General reflux episodes: Mixed or liquid reflux episodes: 143 140 All round reflux episodes: Mixed or liquid reflux episodes: 96 79 Overall reflux episodes: Mixed or liquid reflux episodes: 108Gaseous reflux episodes: 34 Acid reflux episodes: Non- and/or weakly acid reflux episodes: *Scale 0 to ten: 0 = none; ten = unbearable 84Gaseous reflux episodes: three Acid reflux episodes: Non- and/or weakly acid reflux episodes: 15Gaseous reflux episodes: 17 Acid reflux episodes: Non- and/or weakly acid reflux episodes: 17Gaseous reflux episodes: four Acid reflux episodes: Non- and/or weakly acid reflux episodes: 71Subjective symptom scores* – Heartburn + Regurgitation: 5 – Limitation of each day life: five SI: constructive for heartburn and regurgitationSubjective symptom scores* – Heartburn + Regurgitation: 7 – Limitation of everyday life: six SI: positive for heartburn and regurgitationSubjective symptom scores* – Regurgitation: 5 – Limitation of every day life: 5 SI: constructive for regurgitationSubjective symptom scores* – Heartburn, Globus, Bloating: 9 – Limitation of day-to-day life: 9 SI: positive for heartburn, globus and bloatingMII ?multichannel impedance monitoring, SI – symptom index.20-(tert-Butoxy)-20-oxoicosanoic acid Purity Subjective symptom score is depending on the questionnaire previously described by Becker V et al.PMID:24428212 [7]. SI, Symptom index.