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When are reflux episodes symptomatic?
Dis Esophagus 2007; 20(1):47-52DE

Abstract

Careful scrutiny of pH recordings and symptom diaries in patients having 24-hour pH-metry reveals that most reflux episodes are asymptomatic. Although this observation is well known and long recognized, the explanation for why one reflux episode leads to symptoms and others do not is incompletely understood. Forty-four patients with chronic typical gastroesophageal reflux disease (GERD) symptoms referred for ambulatory pH testing were studied. Antisecretory medication was stopped 2 weeks prior to the study. Two meals were taken during the study; one standardized (hamburger, fries, milk-shake) and one at the patient's discretion. A system onset marker noted the type, beginning and end of symptoms (heartburn, regurgitation, chest pain). Age, sex, upright/supine position, nadir pH, time pH < 4, and relationship to meals were compared for symptomatic/asymptomatic reflux episodes. An acid reflux event was defined as a drop in pH < 4 lasting > 5 seconds. The pH catheter detected 1464 reflux episodes. Only 93 (6.3%) were symptomatic. Forty-six of the 93 (49.4%) were associated with heartburn, 38 (40.9%) with regurgitation, and nine (9.7%) with chest pain. Nadir pH was significantly lower in symptomatic episodes. Nearly 50% of symptomatic reflux episodes occurred after meals, especially after non-standardized compared to standardized meal. Symptomatic episodes tended to be longer in duration and to occur in the supine position, while age/sex made no difference. Six percent of the reflux episodes were temporally associated with typical GERD symptoms. This association seems to be influenced by the acidity of the refluxate. Nearly half of the symptomatic reflux episodes occurred after eating.

Authors+Show Affiliations

USC - Thoracic and Foregut Surgery, Los Angeles, California and Rochester School of Medicine - Surgery, Rochester, New York 14645, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17227310

Citation

Portale, G, et al. "When Are Reflux Episodes Symptomatic?" Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus, vol. 20, no. 1, 2007, pp. 47-52.
Portale G, Peters J, Hsieh CC, et al. When are reflux episodes symptomatic? Dis Esophagus. 2007;20(1):47-52.
Portale, G., Peters, J., Hsieh, C. C., Tamhankar, A., Arain, M., Hagen, J., ... DeMeester, T. (2007). When are reflux episodes symptomatic? Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus, 20(1), pp. 47-52.
Portale G, et al. When Are Reflux Episodes Symptomatic. Dis Esophagus. 2007;20(1):47-52. PubMed PMID: 17227310.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - When are reflux episodes symptomatic? AU - Portale,G, AU - Peters,J, AU - Hsieh,C-C, AU - Tamhankar,A, AU - Arain,M, AU - Hagen,J, AU - DeMeester,S, AU - DeMeester,T, PY - 2007/1/18/pubmed PY - 2007/5/11/medline PY - 2007/1/18/entrez SP - 47 EP - 52 JF - Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus JO - Dis. Esophagus VL - 20 IS - 1 N2 - Careful scrutiny of pH recordings and symptom diaries in patients having 24-hour pH-metry reveals that most reflux episodes are asymptomatic. Although this observation is well known and long recognized, the explanation for why one reflux episode leads to symptoms and others do not is incompletely understood. Forty-four patients with chronic typical gastroesophageal reflux disease (GERD) symptoms referred for ambulatory pH testing were studied. Antisecretory medication was stopped 2 weeks prior to the study. Two meals were taken during the study; one standardized (hamburger, fries, milk-shake) and one at the patient's discretion. A system onset marker noted the type, beginning and end of symptoms (heartburn, regurgitation, chest pain). Age, sex, upright/supine position, nadir pH, time pH < 4, and relationship to meals were compared for symptomatic/asymptomatic reflux episodes. An acid reflux event was defined as a drop in pH < 4 lasting > 5 seconds. The pH catheter detected 1464 reflux episodes. Only 93 (6.3%) were symptomatic. Forty-six of the 93 (49.4%) were associated with heartburn, 38 (40.9%) with regurgitation, and nine (9.7%) with chest pain. Nadir pH was significantly lower in symptomatic episodes. Nearly 50% of symptomatic reflux episodes occurred after meals, especially after non-standardized compared to standardized meal. Symptomatic episodes tended to be longer in duration and to occur in the supine position, while age/sex made no difference. Six percent of the reflux episodes were temporally associated with typical GERD symptoms. This association seems to be influenced by the acidity of the refluxate. Nearly half of the symptomatic reflux episodes occurred after eating. SN - 1120-8694 UR - https://www.unboundmedicine.com/medline/citation/17227310/When_are_reflux_episodes_symptomatic L2 - https://academic.oup.com/dote/article-lookup/doi/10.1111/j.1442-2050.2007.00650.x DB - PRIME DP - Unbound Medicine ER -