Authors: Bredenoord, Albert J.¹; Weusten, Bas L.A.M.¹; Timmer, Robin¹; Smout, Andŕe J.P.M.²

Source: The American Journal of Gastroenterology, Volume 101, Number 11, November 2006 , pp. 2470-2475(6)

Publisher: Wiley-Blackwell

Abstract:

OBJECTIVE: In some patients with a physiological esophageal acid exposure, an association between reflux episodes and symptoms can be demonstrated. Besides acidity, other factors such as proximal extent may determine whether a reflux episode is perceived or not. We aimed to investigate the reflux profile of gastroesophageal reflux disease (GERD) patients with physiological acid exposure.

METHODS: Twenty-four-hour impedance-pH monitoring was performed in 14 GERD patients with excessive acid exposure (pH+), 14 GERD patients with physiological acid exposure (pH-), and 14 controls. All patients had a positive symptom-reflux association during 24-h monitoring (SAP+).

RESULTS: The incidence of acid reflux episodes in pH- SAP+ patients (25.5 ± 4.9) and controls (20.2 ± 3.9) was comparable, but lower than in pH+ SAP+ patients (69.8 ± 7.3). However, no differences in number of weakly acidic reflux episodes were observed among pH- SAP+ patients, pH+ SAP+ patients, and controls (27.2 ± 3.8 vs 26.8 ± 4.6 and 21.0 ± 3.7, respectively). The proportion of reflux episodes that reached the proximal esophagus was significantly higher in the pH+ SAP+ (33.5%) and pH- SAP+ (36.0%) patients than in the controls (19.5%). Volume clearance time was longer in pH+ SAP+ (12.5 [12.5-17.0] s) compared with pH- SAP+ patients (12.0 [11.0-16.5] s) and controls (9.5 [10.0-12.5] s) (P < 0.05). Acid clearance time was also longer in pH+ SAP+ patients (55.0 [32.0-64.0] s) compared with the pH- SAP+ (16.5 [11.4-40.0] s) and controls (14 [12.0-19.1] s) (P < 0.01).

CONCLUSIONS: In pH- SAP+ patients, a higher proportion of reflux episodes reach the proximal esophagus than in controls. This can in part explain their symptoms.

(Am J Gastroenterol 2006;101:2470-2475)

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1572-0241.2006.00945.x

Affiliations: 1: Department of Gastroenterology, Sint Antonius Hospital, Nieuwegein, The Netherlands 2: Gastrointestinal Research Unit, Department of Gastroenterology, University Medical Center, Utrecht, The Netherlands

Publication date: 2006-11-01

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