title: Lack of association between esophageal acid sensitivity detected by prolonged pH monitoring and Bernstein testing.
abstract: OBJECTIVE
  Heartburn, a common medical symptom, is thought to be the result of acid reflux into the esophagus. Perfusion of the esophagus with exogenous acid (Bernstein test) in susceptible individuals causes heartburn. Temporal correlation between heartburn and pH drop in the esophagus from endogenous acid, as reflected by a positive symptom index (SI), provides further evidence of a correlation between acid in the esophagus and heartburn. We tested the relationship between heartburn and acid in the esophagus by determining the SI and Bernstein test results in the same individual.
  
  
  METHODS
  Ninety-three patients with heartburn underwent 24-h pH monitoring and Bernstein testing. A Bernstein score that included the severity of heartburn and the time of heartburn onset during Bernstein test was calculated. The relationship between SI, Bernstein test, and Bernstein score was determined.
  
  
  RESULTS
  Fifty-eight patients reported symptoms during the prolonged pH recording. A positive SI was detected in 27 patients. Forty-nine patients had a positive Bernstein test. There was no correlation between the patients with a positive SI and positive Bernstein test results. There was no correlation between SI and Bernstein score. A positive Bernstein test within 5 min of acid infusion did not predict heartburn during spontaneous reflux episodes of >/=5 min.
  
  
  CONCLUSIONS
  The lack of association between symptoms induced by acid perfusion of the esophagus compared with symptoms following spontaneous reflux in the same individual suggests that the heartburn following acid perfusion and spontaneous heartburn are induced by different stimuli.
authors.affiliation: University of California, San Diego, California, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Jung
authors.forename: Joseph
authors.initials: J
authors.lastname: Steinbach
authors.forename: Cheryl
authors.initials: C
authors.lastname: Beaumont
authors.forename: Ravinder K
authors.initials: RK
authors.lastname: Mittal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D012634:Bodily Secretions; D003938:Diagnostic Techniques, Digestive System; D004947:Esophagus / Q000378:metabolism*; D005260:Female; D006356:Heartburn / Q000175:diagnosis / Q000378:metabolism*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D012720:Severity of Illness Index; D013997:Time Factors