Authors: Dickman, Ram¹; Bautista, Jimmy M.¹; Wong, Wai-Man¹; Bhatt, Rajan¹; Beeler, Joy N.¹; Malagon, Isaac¹; Risner-Adler, Sara¹; Lam, Kwok-Fai²; Fass, Ronnie¹

Source: The American Journal of Gastroenterology, Volume 101, Number 11, November 2006 , pp. 2463-2469(7)

Publisher: Wiley-Blackwell

Abstract:

BACKGROUND: Patients with nonerosive reflux disease (NERD) have the lowest esophageal acid exposure profile compared with the other gastroesophageal reflux disease (GERD) groups.

AIM: To compare lower esophageal acid exposure recordings 1 cm above the lower esophageal sphincter (LES) with those 6 cm above the LES as well as to determine the characteristics of esophageal acid exposure along the esophagus among the different GERD groups.

METHODS: Patients with classic heartburn symptoms were enrolled into the study. Patients were evaluated by a demographics questionnaire and the validated GERD Symptom Checklist. Upper endoscopy was performed to evaluate the presence of esophageal erosions and Barrett's esophagus (BE). Ambulatory pH testing was performed using a commercially available 4-sensor pH probe with sensors located 5 cm apart. The distal sensor was placed 1 cm above the LES.

RESULTS: Sixty-four patients completed the study. Of those, 21 patients had NERD, 20 had erosive esophagitis (EE), and 23 had BE. All patient groups demonstrated greater esophageal acid exposure 1 cm above the LES than 6 cm above the LES. In NERD and EE, this phenomenon was primarily a result of a higher mean percentage of upright time with pH <4. Unlike patients with EE and BE, those with NERD had very little variation in esophageal acid exposure throughout the esophagus (total and supine).

CONCLUSIONS: ALL GERD groups demonstrated significant greater esophageal acid exposure at the very distal portion of the esophagus, primarily as a result of short upright reflux events. Unlike erosive esophagitis and BE, NERD patients demonstrate a more homogenous acid distribution along the esophagus.

(Am J Gastroenterol 2006;101:2463-2469)

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1572-0241.2006.00944.x

Affiliations: 1: The Neuro-Enteric Clinical Research Group, Department of Medicine, Section of Gastroenterology, Southern Arizona VA Health Care System and University of Arizona Health Sciences Center, Tucson, Arizona 2: Department of Statistics and Actuarial Science, University of Hong Kong, Hong Kong

Publication date: 2006-11-01

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