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Esophageal motor dysfunction and acid exposure in reflux esophagitis are more severe if Barrett's metaplasia is present.
Am J Gastroenterol 1994; 89(3):349-56AJ

Abstract

OBJECTIVES

To compare esophageal motor function in patients with reflux esophagitis with controls, and identify patient characteristics that may have a bearing on the severity of esophageal motor dysfunction and acid exposure.

METHODS

Esophageal motor function was assessed in 60 patients with reflux esophagitis. All patients had manometry, 50 had an esophageal transit test, and 23 had an acid clearance test. Forty-eight had dual site [5 and 10 cm above lower esophageal sphincter (LES)] esophageal pH monitoring, four had only distal pH monitoring, and one patient had only proximal pH monitoring. Thirty-four controls underwent the same tests. The association between the indices of esophageal function plus the degree of esophageal acid exposure and eight patient characteristics (age, sex, obesity, smoking, alcohol intake, hiatus hernia, grade of esophagitis, and Barrett's metaplasia) was examined in unifactorial and multifactorial analysis of variance.

RESULTS

The patients had significantly lower LES pressure, lower distal and middle esophageal amplitudes, longer duration of contraction, and slower velocity of propagation. They had longer esophageal transit and acid clearance times. Barrett's metaplasia was the only factor that had an association with the magnitude of esophageal motor dysfunction and acid exposure, except age, which had a weak positive association with acid exposure (p = 0.03). Compared to the rest of the patients with esophagitis, patients with Barrett's had lower LES pressure (median = 10.5 vs. 17.5 mm Hg, p = 0.013), longer supine transit time (median = 180 vs. 13.5 s, p = 0.0001), and higher % of total time pH < 4 (median = 48.2 vs. 8.7 and 23.2 vs. 5.2; p < 0.0001 for distal and proximal esophageal acid exposure, respectively). Ten of the 12 patients with Barrett's had abnormal manometry, compared with 20 of the 48 without (chi 2 = 6.67; p < 0.01). There was a strong correlation between the degree of acid exposure in the proximal esophagus and the length of Barrett's segment (r = 0.846, 0.81, 0.725; and p < 0.001, 0.005, 0.018, for the % of times pH < 4 for total, supine, and upright periods, respectively).

CONCLUSIONS

The development of Barrett's metaplasia may be determined by the degree of esophageal exposure to the refluxate which, in turn, may be a function of the severity of esophageal motor dysfunction. The length of Barrett's segment may be dependent on the extent of orad transport of the refluxate.

Authors+Show Affiliations

Department of Gastroenterology, Queen Alexandra Hospital, Cosham, Portsmouth, United Kingdom.No affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

8122643

Citation

Singh, P, et al. "Esophageal Motor Dysfunction and Acid Exposure in Reflux Esophagitis Are More Severe if Barrett's Metaplasia Is Present." The American Journal of Gastroenterology, vol. 89, no. 3, 1994, pp. 349-56.
Singh P, Taylor RH, Colin-Jones DG. Esophageal motor dysfunction and acid exposure in reflux esophagitis are more severe if Barrett's metaplasia is present. Am J Gastroenterol. 1994;89(3):349-56.
Singh, P., Taylor, R. H., & Colin-Jones, D. G. (1994). Esophageal motor dysfunction and acid exposure in reflux esophagitis are more severe if Barrett's metaplasia is present. The American Journal of Gastroenterology, 89(3), pp. 349-56.
Singh P, Taylor RH, Colin-Jones DG. Esophageal Motor Dysfunction and Acid Exposure in Reflux Esophagitis Are More Severe if Barrett's Metaplasia Is Present. Am J Gastroenterol. 1994;89(3):349-56. PubMed PMID: 8122643.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Esophageal motor dysfunction and acid exposure in reflux esophagitis are more severe if Barrett's metaplasia is present. AU - Singh,P, AU - Taylor,R H, AU - Colin-Jones,D G, PY - 1994/3/1/pubmed PY - 1994/3/1/medline PY - 1994/3/1/entrez SP - 349 EP - 56 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 89 IS - 3 N2 - OBJECTIVES: To compare esophageal motor function in patients with reflux esophagitis with controls, and identify patient characteristics that may have a bearing on the severity of esophageal motor dysfunction and acid exposure. METHODS: Esophageal motor function was assessed in 60 patients with reflux esophagitis. All patients had manometry, 50 had an esophageal transit test, and 23 had an acid clearance test. Forty-eight had dual site [5 and 10 cm above lower esophageal sphincter (LES)] esophageal pH monitoring, four had only distal pH monitoring, and one patient had only proximal pH monitoring. Thirty-four controls underwent the same tests. The association between the indices of esophageal function plus the degree of esophageal acid exposure and eight patient characteristics (age, sex, obesity, smoking, alcohol intake, hiatus hernia, grade of esophagitis, and Barrett's metaplasia) was examined in unifactorial and multifactorial analysis of variance. RESULTS: The patients had significantly lower LES pressure, lower distal and middle esophageal amplitudes, longer duration of contraction, and slower velocity of propagation. They had longer esophageal transit and acid clearance times. Barrett's metaplasia was the only factor that had an association with the magnitude of esophageal motor dysfunction and acid exposure, except age, which had a weak positive association with acid exposure (p = 0.03). Compared to the rest of the patients with esophagitis, patients with Barrett's had lower LES pressure (median = 10.5 vs. 17.5 mm Hg, p = 0.013), longer supine transit time (median = 180 vs. 13.5 s, p = 0.0001), and higher % of total time pH < 4 (median = 48.2 vs. 8.7 and 23.2 vs. 5.2; p < 0.0001 for distal and proximal esophageal acid exposure, respectively). Ten of the 12 patients with Barrett's had abnormal manometry, compared with 20 of the 48 without (chi 2 = 6.67; p < 0.01). There was a strong correlation between the degree of acid exposure in the proximal esophagus and the length of Barrett's segment (r = 0.846, 0.81, 0.725; and p < 0.001, 0.005, 0.018, for the % of times pH < 4 for total, supine, and upright periods, respectively). CONCLUSIONS: The development of Barrett's metaplasia may be determined by the degree of esophageal exposure to the refluxate which, in turn, may be a function of the severity of esophageal motor dysfunction. The length of Barrett's segment may be dependent on the extent of orad transport of the refluxate. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/8122643/Esophageal_motor_dysfunction_and_acid_exposure_in_reflux_esophagitis_are_more_severe_if_Barrett's_metaplasia_is_present_ DB - PRIME DP - Unbound Medicine ER -