Document Detail


Review article: acidity and volume of the refluxate in the genesis of gastro-oesophageal reflux disease symptoms.
MedLine Citation:
PMID:  17439501     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: A number of mechanisms, other than acid reflux, may be responsible for the symptoms of gastro-oesophageal reflux disease. AIM: To assess the importance of non-acid reflux mechanisms. METHODS: This review is based on presentations and discussion at a workshop, where specialists in the field analysed data relating to these mechanisms. RESULTS: Weakly acidic reflux, pH (4-7), detected with impedance-pHmetry is associated with regurgitation and atypical gastro-oesophageal reflux disease symptoms. It is not clear whether pepsin and trypsin can elicit symptoms, but bile can elicit heartburn. The magnitude of reflux-induced oesophageal distension can be determined by high frequency ultrasonography and is not reduced by proton pump inhibition, suggesting that persisting symptoms 'on' a proton pump inhibitor may still be due to oesophageal distension by non-acidic reflux. Exaggerated longitudinal muscle contraction can induce non-acid-related heartburn. Preliminary studies showed a positive effect of baclofen, surgery or endoscopic procedures to reduce weakly acidic reflux. CONCLUSION: Mechanisms other than acid reflux are involved in some of the symptoms of gastro-oesophageal reflux disease. Controlled outcome studies are needed to clarify their roles and the indications for antireflux procedures in patients with persistent symptoms whilst 'on' a proton pump inhibitor.
Authors:
D Sifrim; R Mittal; R Fass; A Smout; D Castell; J Tack; H Gregersen
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Alimentary pharmacology & therapeutics     Volume:  25     ISSN:  0269-2813     ISO Abbreviation:  Aliment. Pharmacol. Ther.     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-04-18     Completed Date:  2007-11-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8707234     Medline TA:  Aliment Pharmacol Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  1003-17     Citation Subset:  IM    
Affiliation:
Center for Gastroenterological Research, Catholic University of Leuven, Leuven, Belgium. daniel.sifrim@med.kuleuven.ac.be
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MeSH Terms
Descriptor/Qualifier:
Ambulatory Care / methods
Cough / etiology
Gastric Acid / physiology*
Gastric Acidity Determination
Gastroesophageal Reflux / drug therapy,  etiology*,  surgery
Humans
Hydrogen-Ion Concentration
Proton Pumps / antagonists & inhibitors
Chemical
Reg. No./Substance:
0/Proton Pumps

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


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