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Relationship of severity of gastroesophageal reflux disease with gastric acid secretory profile and esophageal acid exposure during nocturnal acid breakthrough: a study using 24-h dual-channel pH-metry.
Scand J Gastroenterol. 2008; 43(6):654-61.SJ

Abstract

OBJECTIVE

In patients with gastroesophageal reflux disease (GERD), refluxed gastric juice can damage the esophagus, and hence the more acidic the juice, the more the expected damage. Nocturnal acid breakthrough (NAB) is known to occur in GERD patients on treatment with proton-pump inhibitors (PPIs); however, whether this causes esophageal acidification and symptoms is controversial. The aims of this study were to investigate the relationship between gastric acid and the severity of GERD and the esophageal acidification and symptoms during NAB.

MATERIAL AND METHODS

Patients with GERD were evaluated using endoscopy (graded according to the Los Angeles (LA) classification), manometry and 24-h dual-channel pH-metry for esophageal and gastric acid profile and follow-up pH-metry while on PPIs for NAB.

RESULTS

In 61 patients (39.2+/-12.8 years, 40 M) the endoscopic grading was endoscopy negative (ENRD) in 19 (32%), endoscopic (ERD) in 40 (68%), (LA-A in 25, 42.4%, LA-B in12, 20.3%, peptic stricture in 2, 3.4%, and Barrett's esophagus in 1, 1.7%) and 2 patients were unclassified. Patients in the different groups had comparable gastric acid profiles, though esophageal acid exposure was different (LA-B and above versus ENRD, p=0.007; LA-B and above versus LA-A, p=0.003). Patients with NAB (7/18, 39%) had lower gastric pH than patients without NAB (p=0.003) though average esophageal pH and esophageal acid exposure were comparable. Frequency of nocturnal symptoms was comparable in patients with or without NAB (2/7 versus 3/11, p=NS). Lower esophageal sphincter (LES) pressure was negatively correlated with average gastric pH.

CONCLUSIONS

Although severity of GERD is related to esophageal acid exposure, it does not correlate to gastric acid. No difference was found in esophageal acid exposure and nocturnal symptoms in patients with or without NAB.

Authors+Show Affiliations

Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. ghoshal@sgpgi.ac.inNo 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

18569981

Citation

Ghoshal, Uday C., et al. "Relationship of Severity of Gastroesophageal Reflux Disease With Gastric Acid Secretory Profile and Esophageal Acid Exposure During Nocturnal Acid Breakthrough: a Study Using 24-h Dual-channel PH-metry." Scandinavian Journal of Gastroenterology, vol. 43, no. 6, 2008, pp. 654-61.
Ghoshal UC, Chourasia D, Tripathi S, et al. Relationship of severity of gastroesophageal reflux disease with gastric acid secretory profile and esophageal acid exposure during nocturnal acid breakthrough: a study using 24-h dual-channel pH-metry. Scand J Gastroenterol. 2008;43(6):654-61.
Ghoshal, U. C., Chourasia, D., Tripathi, S., Misra, A., & Singh, K. (2008). Relationship of severity of gastroesophageal reflux disease with gastric acid secretory profile and esophageal acid exposure during nocturnal acid breakthrough: a study using 24-h dual-channel pH-metry. Scandinavian Journal of Gastroenterology, 43(6), 654-61. https://doi.org/10.1080/00365520701864635
Ghoshal UC, et al. Relationship of Severity of Gastroesophageal Reflux Disease With Gastric Acid Secretory Profile and Esophageal Acid Exposure During Nocturnal Acid Breakthrough: a Study Using 24-h Dual-channel PH-metry. Scand J Gastroenterol. 2008;43(6):654-61. PubMed PMID: 18569981.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationship of severity of gastroesophageal reflux disease with gastric acid secretory profile and esophageal acid exposure during nocturnal acid breakthrough: a study using 24-h dual-channel pH-metry. AU - Ghoshal,Uday C, AU - Chourasia,Dipti, AU - Tripathi,Shweta, AU - Misra,Asha, AU - Singh,Kartar, PY - 2008/6/24/pubmed PY - 2008/8/30/medline PY - 2008/6/24/entrez SP - 654 EP - 61 JF - Scandinavian journal of gastroenterology JO - Scand. J. Gastroenterol. VL - 43 IS - 6 N2 - OBJECTIVE: In patients with gastroesophageal reflux disease (GERD), refluxed gastric juice can damage the esophagus, and hence the more acidic the juice, the more the expected damage. Nocturnal acid breakthrough (NAB) is known to occur in GERD patients on treatment with proton-pump inhibitors (PPIs); however, whether this causes esophageal acidification and symptoms is controversial. The aims of this study were to investigate the relationship between gastric acid and the severity of GERD and the esophageal acidification and symptoms during NAB. MATERIAL AND METHODS: Patients with GERD were evaluated using endoscopy (graded according to the Los Angeles (LA) classification), manometry and 24-h dual-channel pH-metry for esophageal and gastric acid profile and follow-up pH-metry while on PPIs for NAB. RESULTS: In 61 patients (39.2+/-12.8 years, 40 M) the endoscopic grading was endoscopy negative (ENRD) in 19 (32%), endoscopic (ERD) in 40 (68%), (LA-A in 25, 42.4%, LA-B in12, 20.3%, peptic stricture in 2, 3.4%, and Barrett's esophagus in 1, 1.7%) and 2 patients were unclassified. Patients in the different groups had comparable gastric acid profiles, though esophageal acid exposure was different (LA-B and above versus ENRD, p=0.007; LA-B and above versus LA-A, p=0.003). Patients with NAB (7/18, 39%) had lower gastric pH than patients without NAB (p=0.003) though average esophageal pH and esophageal acid exposure were comparable. Frequency of nocturnal symptoms was comparable in patients with or without NAB (2/7 versus 3/11, p=NS). Lower esophageal sphincter (LES) pressure was negatively correlated with average gastric pH. CONCLUSIONS: Although severity of GERD is related to esophageal acid exposure, it does not correlate to gastric acid. No difference was found in esophageal acid exposure and nocturnal symptoms in patients with or without NAB. SN - 1502-7708 UR - https://www.unboundmedicine.com/medline/citation/18569981/Relationship_of_severity_of_gastroesophageal_reflux_disease_with_gastric_acid_secretory_profile_and_esophageal_acid_exposure_during_nocturnal_acid_breakthrough:_a_study_using_24_h_dual_channel_pH_metry_ L2 - http://www.tandfonline.com/doi/full/10.1080/00365520701864635 DB - PRIME DP - Unbound Medicine ER -