Intra-oesophageal distribution and perception of acid reflux in patients with non-erosive gastro-oesophageal reflux disease.
BACKGROUND
The majority of patients with gastro-oesophageal reflux disease do not present with erosive oesophagitis and make up a heterogeneous group. Patients with non-erosive gastro-oesophageal reflux disease are less responsive than patients with oesophagitis to acid-suppressive therapy.


OBJECTIVE
To assess the role of acid reflux in gastro-oesophageal reflux disease symptoms.


METHODS
The spatio-temporal characteristics of reflux events were analysed and related to reflux perception in 45 patients with non-erosive gastro-oesophageal reflux disease and 20 patients with erosive oesophagitis.


RESULTS
Compared with healthy controls, all patients showed a higher intra-oesophageal proximal spread of acid, which was prominent in patients with non-erosive gastro-oesophageal reflux disease (> 50% of events lasting for 1-2 min). Irrespective of mucosal injury, the risk of reflux perception was very high when acid reached proximal sensors (odds ratio, 7.6; 95% confidence interval, 4.6-12.5), being maximal in patients with non-erosive gastro-oesophageal reflux disease with normal acid exposure time (odds ratio, 11; 95% confidence interval, 5.2-22.3).


CONCLUSIONS
Patients with non-erosive gastro-oesophageal reflux disease are characterized by a significantly higher proportion of proximal acid refluxes and a higher sensitivity to short-lasting refluxes when compared with patients with oesophagitis. The highest proximal acid exposure and highest perception occurred in patients with non-erosive gastro-oesophageal reflux disease presenting with a normal pH-metric profile. The assessment of acid distribution and its perception in the oesophageal body can better identify reflux patients who should benefit from acid-suppressive treatment.
Cicala
M
M
Department of Digestive Disease, University Campus Bio Medico, Rome, Italy. m.cicala@unicampus.it
Emerenziani
S
S
Caviglia
R
R
Guarino
M P L
MP
Vavassori
P
P
Ribolsi
M
M
Carotti
S
S
Petitti
T
T
Pallone
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D004942:Esophagitis, Peptic / Q000503:physiopathology / Q000523:psychology; D005260:Female; D005744:Gastric Acid / Q000737:chemistry; D005764:Gastroesophageal Reflux / Q000503:physiopathology* / Q000523:psychology; D006356:Heartburn / Q000209:etiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D010465:Perception; D012008:Recurrence; D012307:Risk Factors