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Characteristics of reflux episodes and symptom association in patients with erosive esophagitis and nonerosive reflux disease: study using combined impedance-pH off therapy.
Am J Gastroenterol. 2010 May; 105(5):1053-61.AJ

Abstract

OBJECTIVES

We sought to compare reflux and symptom association patterns in patients with nonerosive reflux disease (NERD), erosive esophagitis (EE), and in healthy volunteers (HVs).

METHODS

Patients with EE and NERD underwent combined impedance-pH monitoring. Normal values were defined on the basis of previously collected data from 48 HVs. We evaluated distal esophageal acid exposure time (AET), number and type of reflux episodes (acid, nonacid), acid and bolus clearance times, proximal extension of reflux episodes, and symptom association probability (SAP).

RESULTS

Distal AET (percentage time, pH<4) was higher (P<0.01) in 58 EE patients (median 7.4%, 25-75th percentile 4.2-9.9%) compared with 168 NERD patients (4.2% (1.2-6.4%)) and 48 HVs (0.7% (0.2-1.4%)). Patients with EE and NERD had a higher (P<0.01) number of acid reflux episodes compared with HVs (51 (37-66) vs. 34 (22-51) vs. 17 (8-31); P<0.05), but a similar number of nonacid reflux episodes (22 (15-39) vs. 23 (15-38) vs. 18 (14-26); P=NS). The percentage of reflux episodes reaching the proximal esophagus was higher (P<0.01) in EE patients (57% (45-73%)) than in NERD patients (45% (36-60%)) and HVs (33% (19-46%)). A positive SAP for heartburn or regurgitation was found in 161 of 168 (96%) NERD and 54 of 58 (93%) EE patients (P=NS).

CONCLUSIONS

Acid reflux episodes, volume, and acid clearance are important factors in the pathogenesis of reflux-induced lesions. Nonacid reflux contributes less to esophageal mucosa damage, but is involved in the development of reflux symptoms in both NERD and EE patients.

Authors+Show Affiliations

Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy. edoardo.savarino@unige.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19997095

Citation

Savarino, Edoardo, et al. "Characteristics of Reflux Episodes and Symptom Association in Patients With Erosive Esophagitis and Nonerosive Reflux Disease: Study Using Combined impedance-pH Off Therapy." The American Journal of Gastroenterology, vol. 105, no. 5, 2010, pp. 1053-61.
Savarino E, Tutuian R, Zentilin P, et al. Characteristics of reflux episodes and symptom association in patients with erosive esophagitis and nonerosive reflux disease: study using combined impedance-pH off therapy. Am J Gastroenterol. 2010;105(5):1053-61.
Savarino, E., Tutuian, R., Zentilin, P., Dulbecco, P., Pohl, D., Marabotto, E., Parodi, A., Sammito, G., Gemignani, L., Bodini, G., & Savarino, V. (2010). Characteristics of reflux episodes and symptom association in patients with erosive esophagitis and nonerosive reflux disease: study using combined impedance-pH off therapy. The American Journal of Gastroenterology, 105(5), 1053-61. https://doi.org/10.1038/ajg.2009.670
Savarino E, et al. Characteristics of Reflux Episodes and Symptom Association in Patients With Erosive Esophagitis and Nonerosive Reflux Disease: Study Using Combined impedance-pH Off Therapy. Am J Gastroenterol. 2010;105(5):1053-61. PubMed PMID: 19997095.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characteristics of reflux episodes and symptom association in patients with erosive esophagitis and nonerosive reflux disease: study using combined impedance-pH off therapy. AU - Savarino,Edoardo, AU - Tutuian,Radu, AU - Zentilin,Patrizia, AU - Dulbecco,Pietro, AU - Pohl,Daniel, AU - Marabotto,Elisa, AU - Parodi,Andrea, AU - Sammito,Giorgio, AU - Gemignani,Lorenzo, AU - Bodini,Giorgia, AU - Savarino,Vincenzo, Y1 - 2009/12/08/ PY - 2009/12/10/entrez PY - 2009/12/10/pubmed PY - 2010/6/3/medline SP - 1053 EP - 61 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 105 IS - 5 N2 - OBJECTIVES: We sought to compare reflux and symptom association patterns in patients with nonerosive reflux disease (NERD), erosive esophagitis (EE), and in healthy volunteers (HVs). METHODS: Patients with EE and NERD underwent combined impedance-pH monitoring. Normal values were defined on the basis of previously collected data from 48 HVs. We evaluated distal esophageal acid exposure time (AET), number and type of reflux episodes (acid, nonacid), acid and bolus clearance times, proximal extension of reflux episodes, and symptom association probability (SAP). RESULTS: Distal AET (percentage time, pH<4) was higher (P<0.01) in 58 EE patients (median 7.4%, 25-75th percentile 4.2-9.9%) compared with 168 NERD patients (4.2% (1.2-6.4%)) and 48 HVs (0.7% (0.2-1.4%)). Patients with EE and NERD had a higher (P<0.01) number of acid reflux episodes compared with HVs (51 (37-66) vs. 34 (22-51) vs. 17 (8-31); P<0.05), but a similar number of nonacid reflux episodes (22 (15-39) vs. 23 (15-38) vs. 18 (14-26); P=NS). The percentage of reflux episodes reaching the proximal esophagus was higher (P<0.01) in EE patients (57% (45-73%)) than in NERD patients (45% (36-60%)) and HVs (33% (19-46%)). A positive SAP for heartburn or regurgitation was found in 161 of 168 (96%) NERD and 54 of 58 (93%) EE patients (P=NS). CONCLUSIONS: Acid reflux episodes, volume, and acid clearance are important factors in the pathogenesis of reflux-induced lesions. Nonacid reflux contributes less to esophageal mucosa damage, but is involved in the development of reflux symptoms in both NERD and EE patients. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/19997095/Characteristics_of_reflux_episodes_and_symptom_association_in_patients_with_erosive_esophagitis_and_nonerosive_reflux_disease:_study_using_combined_impedance_pH_off_therapy_ L2 - http://Insights.ovid.com/pubmed?pmid=19997095 DB - PRIME DP - Unbound Medicine ER -