Importance of Additional Reflux Events During Esophageal Acid Clearing

Abstract

Decreased swallow frequency and low-amplitude ornonconducted primary peristaltic contractions arereported to prolong acid clearing in gastroesophagealreflux disease (GERD) patients. The aim of this study is to investigate which of these, or otherfactors, have a dominant role in long-duration pH refluxevents (pHRE). Simultaneous manometry and pH monitoringwas performed for 40 min before and after (beginning 40 min postprandial) a test meal. Wearbitrarily chose 180 sec to divide pHREs into long orshort pHREs. Twenty GERD patients with and withoutesophagitis were studied. Esophagitis patients hadthreefold more long pHREs than patients withoutesophagitis. In most (56%) long pHREs, additional refluxevents during acid clearing was the only finding. Only11% of long pHREs had either a decreased swallow rate (3%) or decreased peristaltic contractionamplitude (8%), as the only finding contributing to pooracid clearing. However, 18% of long pHREs had one ofthese peristaltic dysfunctions in combination with additional reflux events prolonging acidclearing. Only 15% of long pHREs had no apparent reasonfor poor acid clearing. In interpreting 24-hr pHmonitoring, one should not assume prolonged acidclearing is due to peristaltic dysfunction; instead, itis often due to additional reflux events.