Document Detail


NERD, GERD, and Barrett's esophagus: role of acid and non-acid reflux revisited with combined pH-impedance monitoring.
MedLine Citation:
PMID:  18438712     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Gastroesophageal reflux is the most important factor in the development of Barrett's metaplasia. The effect of acid reflux is commonly accepted today, but there is controversy about the role of non-acid reflux. With introduction of combined esophageal pH-impedance monitoring, a precise diagnostic test for acid and non-acid reflux is now available. METHODS: Ninety two consecutive patients (33 women) off acid-suppressive therapy underwent diagnostic work-up for suspected gastroesophageal reflux disease including upper-GI endoscopy, esophageal manometry, barium swallow, and combined esophageal pH-impedance monitoring. Patients were subdivided into three groups according to symptoms and endoscopic appearance: typical symptoms without esophagitis (n = 28; NERD); erosive esophagitis (n = 52, ERD), and patients with intestinal metaplasia (n = 12, BE). RESULTS: Pathologic acid reflux during pH-metry was found in 35.7%, 63.5%, and 75.0% for NERD, ERD, and BE patients, respectively (P = 0.022). Likewise, the percentage of time pH < 4 rose significantly during upright, supine, and total phases. In contrast, combined pH-impedance monitoring showed no significant difference between groups for the number of acid reflux events and for percentage of acid bolus reflux time. However, BE patients had significantly more non-acid reflux events and a higher percentage of non-acid bolus reflux time during the supine (P = 0.043, P = 0.020, respectively), but not during the upright phase (P = 0.740, P = 0.730, respectively). CONCLUSION: Patients with BE are exposed to increased supine non-acid reflux and to increased acid reflux during upright and supine phases. This observation supports the concept that nocturnal non-acid reflux may play a role in the pathogenesis of BE.
Authors:
Christian A Gutschow; Marc Bludau; Daniel Vallböhmer; Wolfgang Schröder; Elfriede Bollschweiler; Arnulf H Hölscher
Publication Detail:
Type:  Journal Article     Date:  2008-04-26
Journal Detail:
Title:  Digestive diseases and sciences     Volume:  53     ISSN:  0163-2116     ISO Abbreviation:  Dig. Dis. Sci.     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-11-12     Completed Date:  2009-02-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7902782     Medline TA:  Dig Dis Sci     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3076-81     Citation Subset:  AIM; IM    
Affiliation:
Department of Visceral and Vascular Surgery, University of Cologne, Kerpener Strasse 62, 50962, Cologne, Germany. ch.gutschow@t-online.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Barrett Esophagus / physiopathology*
Bile Acids and Salts
Endoscopy, Digestive System
Esophageal pH Monitoring*
Esophagitis / physiopathology*
Female
Gastroesophageal Reflux / physiopathology*
Humans
Intestines / metabolism,  pathology
Male
Manometry
Metaplasia
Middle Aged
Retrospective Studies
Chemical
Reg. No./Substance:
0/Bile Acids and Salts

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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