Review article: acidity and volume of the refluxate in the genesis of gastro-oesophageal reflux disease symptoms.
BACKGROUND
A number of mechanisms, other than acid reflux, may be responsible for the symptoms of gastro-oesophageal reflux disease.


OBJECTIVE
To assess the importance of non-acid reflux mechanisms.


METHODS
This review is based on presentations and discussion at a workshop, where specialists in the field analysed data relating to these mechanisms.


RESULTS
Weakly acidic reflux, pH (4-7), detected with impedance-pHmetry is associated with regurgitation and atypical gastro-oesophageal reflux disease symptoms. It is not clear whether pepsin and trypsin can elicit symptoms, but bile can elicit heartburn. The magnitude of reflux-induced oesophageal distension can be determined by high frequency ultrasonography and is not reduced by proton pump inhibition, suggesting that persisting symptoms 'on' a proton pump inhibitor may still be due to oesophageal distension by non-acidic reflux. Exaggerated longitudinal muscle contraction can induce non-acid-related heartburn. Preliminary studies showed a positive effect of baclofen, surgery or endoscopic procedures to reduce weakly acidic reflux.


CONCLUSIONS
Mechanisms other than acid reflux are involved in some of the symptoms of gastro-oesophageal reflux disease. Controlled outcome studies are needed to clarify their roles and the indications for antireflux procedures in patients with persistent symptoms whilst 'on' a proton pump inhibitor.
Sifrim
D
D
Center for Gastroenterological Research, Catholic University of Leuven, Leuven, Belgium. daniel.sifrim@med.kuleuven.ac.be
Mittal
R
R
Fass
R
R
Smout
A
A
Castell
D
D
Tack
J
J
Gregersen
H
H
D000553:Ambulatory Care / Q000379:methods; D003371:Cough / Q000209:etiology; D005744:Gastric Acid / Q000502:physiology*; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D006801:Humans; D006863:Hydrogen-Ion Concentration; D054328:Proton Pump Inhibitors
D054328:Proton Pump Inhibitors