Duodenogastric and non acid gastro-oesophageal reflux in patients with reflux oesophagitis.
OBJECTIVE
The role and the identification criteria of non acid gastro-oesophageal reflux (GOR) are still debated. Moreover, the relationship between nonacid GOR and gastric alkalinizations, particularly if secondary to duodeno-gastric reflux is yet to be defined.


METHODS
One hundred and forty one patients affected by GORD symptoms and oesophagitis entered the study. Oesophagitis was divided into four categories, according to a modified Savary and Miller classification. Acid (pH<4), alkalacid (4<pH>7), alkaline (pH>7) GOR and duodenogastric reflux were measured by means of ambulatory three channel esophago-gastric pH monitoring with a combined analysis of the pH traces recorded in the oesophagus fundus and antrum.


RESULTS
Total time percentage (T%) of acid GOR was significantly greater in patients than in healthy volunteers (HV) and between groups of patients in direct relation with the severity of the oesophagitis. Alkaline GOR was hardly detectable in every class of esophagitis. Alkalacid GOR increased with the grade of severeness of oesophagitis. Alkalacid GOR occurred prevalently in the postprandial period; it was only 8% of the time in patients with mild reflux oesophagitis and even less in patients with moderate or severe oesophagitis. The 24 hr total time percentage of duodenogastric reflux was similar in the patients and healthy volunteer groups. The frequency distribution in 0.1 intervals of fundic and antral pH samples showed a greater number of them in the acid range (0.8-1.2) in the patients than in healthy volunteer group (0.0006<p<0.05). The frequency distribution of alkalacid (4<pH<7) and alkaline (pH>7) samples was similar in patients and in healthy volunteers.


CONCLUSIONS
Our findings demonstrate that alkaline GOR is rare in GORD patients and that non acid GOR has a minor role in the pathophysiology of reflux esophagitis.
Mattioli
S
S
Istituto di Clinica Chirurgica II, Pol. S. Orsola Universita di Bologna, Italy.
Felice
V
V
Pastina
M
M
Pilotti
V
V
D'Ovidio
F
F
Bacchi
M L
ML
Gozzetti
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D004383:Duodenogastric Reflux / Q000150:complications* / Q000503:physiopathology; D004942:Esophagitis, Peptic / Q000150:complications* / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence