title: Pathological bolus exposure may define gastro-esophageal reflux better than pathological acid exposure in patients with globus.
abstract: OBJECTIVE
  Conventionally, pathological acid exposure (PAE), defined by acid reflux only, is used to identify gastro-esophageal reflux disease (GERD). However, weak acid reflux or non-acid reflux also induces reflux symptoms. Defining abnormal reflux based on all reflux episodes may better identify GERD and would be more useful among patients with atypical GERD symptoms, such as globus.
  
  
  METHODS
  Impedance-pHmetry results of 31 globus patients, off acid suppressants, were analysed.
  
  
  RESULTS
  A median of 24 episodes of reflux were observed. Of the reflux episodes, 54% were non-acid reflux and 50% reached the proximal extent. PAE was observed in 6 patients (19%). For 5 patients (16%) without PAE, there was evidence of increased bolus exposure compared to normal controls (an intraesophageal bolus exposure for more than 1.4% of the recording time, defined as pathological bolus exposure, PBE). When GERD was defined by PAE or esophagitis, the prevalence of GERD was 29%. When GERD was defined by PBE, PAE or esophagitis, the prevalence was 42%. PBE identified 13% of the patients who otherwise would have been missed.
  
  
  CONCLUSIONS
  A significant proportion of patients without PAE had evidence of PBE. PBE may be a more useful definition for identifying patients with abnormal increase in reflux in patients with globus. Further studies are warranted.
authors.affiliation: Department of Medicine, Samsung Medical Center, Seoul, Korea.
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Sinn
authors.forename: Beom Jin
authors.initials: BJ
authors.lastname: Kim
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Son
authors.forename: Jae J
authors.initials: JJ
authors.lastname: Kim
authors.forename: Jong Chul
authors.initials: JC
authors.lastname: Rhee
authors.forename: Poong-Lyul
authors.initials: PL
authors.lastname: Rhee
mesh_terms: D000328:Adult; D000368:Aged; D050782:Esophageal pH Monitoring; D004941:Esophagitis / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D005753:Gastric Mucosa / Q000378:metabolism*; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology