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Determinants of perception of heartburn and regurgitation.
Gut 2006; 55(3):313-8Gut

Abstract

BACKGROUND AND AIMS

It is not known why some reflux episodes evoke symptoms and others do not. We investigated the determinants of perception of gastro-oesophageal reflux.

METHODS

In 32 patients with symptoms suggestive of gastro-oesophageal reflux, 24 hour ambulatory pH and impedance monitoring was performed after cessation of acid suppressive therapy. In the 20 patients who had at least one symptomatic reflux episode, characteristics of symptomatic and asymptomatic reflux episodes were compared.

RESULTS

A total of 1807 reflux episodes were detected, 203 of which were symptomatic. Compared with asymptomatic episodes, symptomatic episodes were associated with a larger pH drop (p<0.001), lower nadir pH (p<0.05), and higher proximal extent (p<0.005). Symptomatic reflux episodes had a longer volume and acid clearance time (p<0.05 and p<0.002). Symptomatic episodes were preceded by a higher oesophageal cumulative acid exposure time (p<0.05). The proximal extent of episodes preceding regurgitation was larger than those preceding heartburn; 14.8% of the symptomatic reflux episodes were weakly acidic. In total, 426 pure gas reflux episodes occurred, of which 12 were symptomatic. Symptomatic pure gas reflux was more frequently accompanied by a pH drop than asymptomatic gas reflux (p<0.05).

CONCLUSIONS

Heartburn and regurgitation are more likely to be evoked when the pH drop is large, proximal extent of the refluxate is high, and volume and acid clearance is delayed. Sensitisation of the oesophagus occurs by preceding acid exposure. Weakly acidic reflux is responsible for only a minority of symptoms in patients off therapy. Pure gas reflux associated with a pH drop ("acid vapour") can be perceived as heartburn and regurgitation.

Authors+Show Affiliations

Department of Gastroenterology, St Antonius Hospital, PO Box 2500, 3430 EM Nieuwegein, and Gastrointestinal Research Centre, University Medical Centre, Utrecht, the Netherlands. a.bredenoord@antonius.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16120760

Citation

Bredenoord, A J., et al. "Determinants of Perception of Heartburn and Regurgitation." Gut, vol. 55, no. 3, 2006, pp. 313-8.
Bredenoord AJ, Weusten BL, Curvers WL, et al. Determinants of perception of heartburn and regurgitation. Gut. 2006;55(3):313-8.
Bredenoord, A. J., Weusten, B. L., Curvers, W. L., Timmer, R., & Smout, A. J. (2006). Determinants of perception of heartburn and regurgitation. Gut, 55(3), pp. 313-8.
Bredenoord AJ, et al. Determinants of Perception of Heartburn and Regurgitation. Gut. 2006;55(3):313-8. PubMed PMID: 16120760.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Determinants of perception of heartburn and regurgitation. AU - Bredenoord,A J, AU - Weusten,B L A M, AU - Curvers,W L, AU - Timmer,R, AU - Smout,A J P M, Y1 - 2005/08/24/ PY - 2005/8/27/pubmed PY - 2006/3/15/medline PY - 2005/8/27/entrez SP - 313 EP - 8 JF - Gut JO - Gut VL - 55 IS - 3 N2 - BACKGROUND AND AIMS: It is not known why some reflux episodes evoke symptoms and others do not. We investigated the determinants of perception of gastro-oesophageal reflux. METHODS: In 32 patients with symptoms suggestive of gastro-oesophageal reflux, 24 hour ambulatory pH and impedance monitoring was performed after cessation of acid suppressive therapy. In the 20 patients who had at least one symptomatic reflux episode, characteristics of symptomatic and asymptomatic reflux episodes were compared. RESULTS: A total of 1807 reflux episodes were detected, 203 of which were symptomatic. Compared with asymptomatic episodes, symptomatic episodes were associated with a larger pH drop (p<0.001), lower nadir pH (p<0.05), and higher proximal extent (p<0.005). Symptomatic reflux episodes had a longer volume and acid clearance time (p<0.05 and p<0.002). Symptomatic episodes were preceded by a higher oesophageal cumulative acid exposure time (p<0.05). The proximal extent of episodes preceding regurgitation was larger than those preceding heartburn; 14.8% of the symptomatic reflux episodes were weakly acidic. In total, 426 pure gas reflux episodes occurred, of which 12 were symptomatic. Symptomatic pure gas reflux was more frequently accompanied by a pH drop than asymptomatic gas reflux (p<0.05). CONCLUSIONS: Heartburn and regurgitation are more likely to be evoked when the pH drop is large, proximal extent of the refluxate is high, and volume and acid clearance is delayed. Sensitisation of the oesophagus occurs by preceding acid exposure. Weakly acidic reflux is responsible for only a minority of symptoms in patients off therapy. Pure gas reflux associated with a pH drop ("acid vapour") can be perceived as heartburn and regurgitation. SN - 0017-5749 UR - https://www.unboundmedicine.com/medline/citation/16120760/Determinants_of_perception_of_heartburn_and_regurgitation_ L2 - http://gut.bmj.com/cgi/pmidlookup?view=long&amp;pmid=16120760 DB - PRIME DP - Unbound Medicine ER -