反流性食管炎与非糜烂性反流病食管酸暴露的特点比较

目的　比较反流性食管炎 (RE)与非糜烂性反流病 (NERD)各亚组食管酸暴露特点。方法　具有典型反酸 烧心等症状的 12 8例患者 ,经胃镜等系统检查诊断为胃食管反流病 (GERD)。便携式 pH监测仪行胃食管 2 4hpH监测 ,DeMeester积分≥ 15分为存在病理性酸反流。 结果　 12 8例患者中 ,37例 (2 8 9% )存在RE ,91例 (71 1% )为NERD。pH监测阳性在RE组和NERD组中分别为 2 5例 (6 7 6 % )和 4 6例 (5 0 5 % ) ,差异无统计学意义 ;两组DeMeester积分均值差异亦无统计学意义 (5 3 4 5± 6 2 0 4比 4 0 0 4± 6 1 80 ,P >0 0 5 )。RE组长反流次数显著高于NERD组 (8 16±10 2 7比 3 96± 6 87,P =0 0 0 4 )。以症状指数 >5 0 %为阳性 ,NERD阳性组 (pH值监测异常 )症状指数阳性率显著高于NERD阴性组 (pH值监测正常 ) (43 5 %比 15 6 % ,P <0 0 0 1)。NERD阴性组中具有阳性症状指数的患者 7例 (15 6 % ) ,阴性症状指数者 38例。前者总反流次数及立位反流时间百分比显著高于后者。RE患者中 ,12例 pH监测阴性者食管及胃内pH的中位值显著高于 pH监测阳性者。结论　RE患者长反流发生率高于NERD患者 ;症状的发生与酸反流相关 ;NERD患者根据酸反流与症状关系可分为不同的亚组。RE阴性组可能存在混合反流或胆汁反流     

小儿非心源性胸痛与胃食管反流的关系

目的了解小儿非心源性胸痛(NCCP)与胃食管反流(GER)的关系,探讨食管pH值监测在小儿NCCP诊断中的意义。方法对36例(病例组)诊断为NCCP并排除呼吸系统和胸部肌肉骨骼病变患儿进行24 h食管pH值监测,其中20例行胃镜检查。根据食管炎诊断标准,诊断为食管炎(食管炎组)11例,非食管炎(非食管炎组)9例。结果病例组24 h食管pH值<4、反流≥5 min、最长反流时间、酸性反流指数、Boix-Ochoa评分分别为(60±7)次、(2．44±0．74)次、(12．4±2．8)min、6．72±1．39、(24．6±3．9)分,对照组分别为(33±4)次、(0．35±0．11)次、(4．3±0．9) min、1．25±0．19、(7．7±0．9)分,两组比较差异有统计学意义(t分别=3．44、2．79、2．73、3．89、4．24, P均<0．01);以Boix-Ochoa评分>11．99为病理性GER诊断标准,病例组GER阳性为58．3％(21／36)。20例经胃镜检查的患者中诊断为食管炎为55．0％(11／20),其中GER阳性为81．8％(9／11);诊断为非食管炎为45．0％(9／20),其中GER阳性者为33．3％(3／9)。食管炎组反流≥5 min、酸性反流指数分别为(5．8±2．0)次、12．5±3．5,非食管炎组分别为(0．9±0．5)次、3．4±1．4,两组比较差异有统计学意义(Z分别=-2．400、-2．545,P均<0．05);食管炎组24 h食管pH值<4、最长反流时间、Boix-Ochoa评分分别为(73±11)次、(26±7)min、(41±10)分,非食管炎组分别为(34±11)次、(4±3)min、(14±5)分,两组比较差异有统计学意义(Z值分别为-2．926、-2．675、-2．584,P均<0．01)。结论GER是小儿NCCP的重要原因,食管pH值监测有助于小儿NCCP的病因诊断,并能指导治疗。     

24h食管pH监测在胃食管反流病的临床应用

目的　应用 2 4h食管 pH监测仪 ,检测食管下段 pH值 ,旨在为胃食管反流病 (GERD)提供灵敏性和特异性较高、先进而方便、快捷的诊断方法。方法　正常对照组 2 0例 ,消化性溃疡 5 4例及GERD组 85例 ,均采用Digi trapperMKⅢ 2 4hpH监测仪记录下食管括约肌 (LES)上 5cm处 pH。 结果　GERD组 2 4h食管pH监测有关指标均分别显著高于对照组和消化性溃疡组 (P <0 0 1) ,后二者间比较差异无显著性 (P >0 0 5 ) ;GERD组中有 2 4例内镜无异常的异常反流患者 ,其 2 4h食管 pH监测与 6 1例反流性食管炎比较 ,无显著性差异 (P >0 0 5 )。结论　GERD的症状分析和内镜诊断均有其局限性 ,2 4h食管 pH监测是GERD诊断的确切标准。     

食管内酸、胆盐监测及内镜检查对胃食管反流病的诊治意义

目的探索胃食管反流病(GERD)的合理治疗方案.方法应用24 h食管内胆红素与pH监测,对110例有GERD症状的患者检测24 h食管内胆汁反流情况及pH动态变化,结合内镜检查来综合分析.结果根据24 h食管内酸和胆红素监测的结果,以内镜检查有无黏膜病变而分成两组.内镜检查阳性组25例(22.7%)均有酸(碱)病理性反流;内镜检查阴性组85例(77.3%),其中73例有酸(碱)病理性反流,另12例(10.9%)反流在生理范围内.内镜检查阳性组与阴性组有反流者相比,差异无显著性(P＞0.05),但内镜检查阳性组和阴性组有反流者与内镜阴性且反流在生理范围者相比均差异有显著性(P＜0.05).结论根据24 h食管内监测及内镜检查结果,显示89%GERD均有酸(碱)病理性反流,酸(碱)反流是导致临床症状和食管黏膜损伤的主要攻击因子,削弱或消除反流是GERD治疗的关键.GERD易复发,需长期维持治疗,应特别注意药效、不良反应和经济学问题.     

支气管哮喘病人24小时食管pH监测的临床分析

目的　观察哮喘发作期及缓解期患者食管 2 4hpH的变化 ,研究胃食管反流 (GER)病人应用抑酸剂后食管 pH或肺功能的改变情况。方法　对 5 1例哮喘病人进行了研究 ,其中 30例病人比较发作期及缓解 2周后的 2 4h食管 pH指标 ,对 16例伴有GER的哮喘缓解期病人 ,应用奥米拉唑治疗 ,比较治疗前及治疗 2周后肺功能指标。对 15例伴有GER的急性哮喘发作病人应用奥米拉唑治疗 ,比较治疗前及治疗 2周后 2 4h食管 pH的变化。结果　哮喘发作期及缓解期 2 4h食管pH各项指标与正常对照组比较显著升高 (P <0 0 1)。 16例伴有GER的哮喘缓解期病人 ,应用抑酸剂后肺功能有明显改善 (P <0 0 5 )。 15例伴有GER的哮喘急性发作期病人经抑酸剂治疗后 ,13例食管 2 4hpH监测的各项指标明显降低 (P <0 0 1)。结论　哮喘急性发作期及缓解期 ,GER发生率显著升高 ,有GER的哮喘病人肺功能有明显改变 ,对哮喘发作的病人 ,需常规进行食管 2 4hpH监测 ,发现有GER的病人 ,可采取质子泵抑制剂治疗     

胃食管反流性咳嗽的临床分析

目的　探讨胃食管反流 (GER)性咳嗽的临床特征、诊断和治疗。方法　对 4 1例X线胸片、组胺激发试验、鼻部检查正常的慢性咳嗽患者进行 2 4h食管 pH监测 ,并利用症状相关性概率(SAP)来分析咳嗽与反流的相关性。对Demeester总积分≥ 14 72 ,和 (或 )咳嗽与反流SAP≥ 75 %者进行为期 12周的抗反流治疗。结果　 4 1例患者中 ,有 2 6例诊断为GER性咳嗽 ,并给予抗反流治疗 ,完成疗程后 ,有 12例患者咳嗽完全消失 ,咳嗽与反流的SAP(上电极为 0 75± 0 2 1,下电极为0 91± 0 12 )显著高于另 14例对抗反流治疗反应较差或无效的患者 (上电极为 0 36± 0 31,下电极为 0 4 7± 0 30 ;P <0 0 5 )。结论　GER是不明原因慢性咳嗽的一个重要的独立原因。 2 4h食管 pH监测结合症状相关性分析有助于GER性咳嗽的诊断 ,抗反流治疗对其有较好的近期疗效。     

支气管哮喘患者与胃食管返流的症状相关性

目的　探讨胃食管返流 (GER)与成人中、重度支气管哮喘的症状相关性 ,了解 2 4h食管pH监测对哮喘合并GER的诊断价值及抗返流治疗对合并GER的哮喘患者症状的影响。方法　对 2 6例常规治疗后仍有顽固性咳嗽等症状的成人哮喘患者进行 2 4h食管pH监测 ,严格记录监测期间患者出现的各种症状 ,每小时记录 1次呼气峰流速 (PEF)。筛选出适当病例分组抗返流治疗并观察疗效。结果　 2 6例中有 15例DeMeester总积分≥ 14 72 ,2例虽DeMeester总积分 <14 72 ,但咳嗽与返流的症状相关概率 (SAP)≥ 95 % ,共筛选出 17例。将 17例患者随机分为治疗组 (9例 )和对照组 (8例 )。经抗返流治疗后 ,治疗组咳嗽、胸闷和胸骨后烧灼感等症状均较对照组有明显改善 ,2 4hPEF波动率治疗前 [(3 8± 8) % ]、后 [(16± 3 ) % ]比较差异有显著性 (P <0 0 5 )。结论　 (1)中、重度支气管哮喘患者具有较高的GER发生率 (5 8% )。 (2 ) 2 4h食管pH监测有助于了解哮喘患者的症状与GER的相关性。 (3 )对于有GER并与哮喘症状密切相关的患者 ,抗返流治疗可显著地改善其症状及PEF波动率     

胃酸在十二指肠液反流诱发食管腺癌中的作用

目的　探讨胃酸在十二指肠液反流诱发食管腺癌 (EAC)过程中的作用。方法　采用SD大鼠 ,通过手术产生三个实验组 :胃食管反流 (GER)组、十二指肠食管反流 (DER)组以及十二指肠胃食管反流 (DGER)组 ,并设无反流的假手术 (SO)对照组。术后 2 0周观察各组动物食管黏膜病变。结果　SO组未见明显病理学改变。各反流组均引发不同程度的食管炎。DER和DGER组基底细胞增生、鳞状上皮不典型增生和溃疡发生率显著高于GER组 (P <0 .0 1)。GER组没有出现Barrett’s食管 (BE)和食管腺癌 (EAC)。DER和DGER组BE发生率分别为 91.4 %和 84 .4 % ,EAC发生率分别为 2 5 .7%和5 3.1% ,均显著高于GER组 (P <0 .0 1)。DGER组EAC发生率显著高于DER组 (P <0 .0 5 )。结论　胃、十二指肠液反流均造成食管黏膜损伤 ,后者更为严重 ;十二指肠液反流在BE、EAC发展中发挥着尤为关键性的作用 ;胃酸在十二指肠液反流诱发EAC过程中起促进作用 ,显著增加十二指肠液反流诱发EAC的危险性     

十二指肠球部溃疡伴胃食管反流患者食管动力及胃内pH值监测

目的：探讨胃食管反流(GER)常见于十二指肠球部溃疡的原因。方法：选择近5年我院接受胃食管动力检查并行胃镜检查明确诊断为十二指肠球部溃疡的患者46例。食管pH监测胃食管酸反流阳性或胃镜检查存在反流性食管炎(RE)者为反流组，食管pH值监测胃食管酸反流阴性者为非反流组。比较两组食管下括约肌(IES)、食管体部及食管上括约肌(UES)等功能差别，同时对两组胃pH值监测进行比较。结果：十二指肠球部溃疡患者为GER／RE的高发人群，反流组与非反流组LES长度、功能压、食管体部清除功能、UES静息压比较差异无显著性。反流组每日不同时限胃酸分泌高于非反流组。结论：十二指肠球部溃疡易合并GER／RE与胃酸增高有关，与食管动力变化关系不大。     

运动试验在高血压病人中的诊断意义

研究有心前区疼痛发作的高血压病人平板运动试验特点。对 71例有心前区疼痛发作的高血压病人 (HP)与 6 4例有心前区疼痛发作的非高血压病人 (NHP)均进行平板运动试验及冠状动脉造影检查 ,HP、NHP组运动试验阳性分别为 51例、4 1例 ,阴性者为 2 0例、2 3例。结果发现冠脉有病变者 37例、4 6例 ,无病变者 34例、18例。 2组病人敏感性 (86 .5% ,82 .6 % )、阴性预测值 (75.0 % ,6 5.2 % )无显著性差异 (P >0 .0 5) ,而特异性 (83.3% ,4 4 .19% )、阳性预测值 (92 .6 % ,6 2 .7% )、准确性 (82 .8% ,6 6 .2 % )NHP组高于HP组 (P <0 .0 5)。HP组病人平板运动试验发生心电图ST段下移时间比NHP组延迟出现 (P <0 .0 1) ,其冠脉造影阳性组最大ST段下移幅度大于冠脉造影阴性组 (P <0 .0 5)。结论 :高血压病人运动试验假阳性率增加 ,这部分病人心电图ST段下移延迟出现 ,且最大ST段下移幅度小。     

Thresholds of gastroesophageal reflux for diagnosis of esophageal reflux diseases

AIM: To establish the optimal thresholds of pH variation (pH fluctuations and reflux episodes) for separating physiological and pathological gastroesophageal reflux (GER), and to evaluate their significance for GER diagnosis. METHODS: Twenty-four hour intraesophageal pH monitoring and endoscopy were performed in 400 patients with GER symptoms and in 100 healthy controls. RESULTS: The percentages of the time with pH fluctuations in patients with and without esophagitis, and in healthy controls were, on average, 12.65%, 9.5% and 2.76% in 24 h, respectively, and the respective percentages of the time with reflux episodes in the same groups in 24 h were, on average, 3.12%, 2.04% and 0.18%, respectively. Using a receiver-operating-characteristic curve analysis, < 6.7% of the time with pH fluctuations and 0.1% of the time with reflux episodes were defined as the combined thresholds for physiological versus pathological reflux. The sensitivity of the combined thresholds for the detection of GER in patients with and without esophagitis was 96.7% and 90.0%, respectively, and the specificity for the diagnosis of patients with abnormal GER disease was 100%. CONCLUSION: pH fluctuations and reflux episodes, when evaluated together, are more useful for classifying patients with GER; the combined thresholds yield higher diagnostic accuracy for assessing patients with GER disease.     

胃食管反流阈值诊断食管反流性疾病

目的研究区别生理性和病理性胃食管反流性的 pH 值变化。方法胃食管反流症状患者400名及键康对照者100名接受食管内24 h 连续 pH 监测和纤维内镜检查。结果 24 h 内 pH 波动的百分时间分别是:食管炎组12.7%;非食管炎组9.5%;健康对照组2.8%。24内反流发作的百分时间为:食管炎组3.12%;非食管炎组2.04%;健康对照组0.18%。应用接受—生效—特征曲线分析法,将 pH 波动<6.7%和反流发作<0.1%确定为诊断生理性反流和病理性反流的复合阈值。应用该复合阈值对反流性食管炎的诊断敏感性为96.7%,对非食管炎的胃食管反流患者的诊断敏感性为90%;其诊断异常胃一食管反流的特异性为100%。结论将 pH 波动与反流发作两个指标作为复合闽值用于诊断胃—食管反流患者,很有价值,在诊断胃—食管反流患者时具有较高的精确度。     

pH fluctuations versus reflux episodes in patients with gastroesophageal reflux disease: their optimal thresholds and significance in diagnosis.

In physiological and pathological conditions, pH monitoring in the esophagus shows small variations as well as more pronounced deflections. However, only the latter are traditionally taken into account in 24-hour pH monitoring analysis. The present study was designed to establish optimal thresholds of pH fluctuations versus reflux episodes in separating physiological and pathological gastroesophageal reflux (GER) and to evaluate their significance in the diagnosis. Twenty-four-hour intraesophageal pH monitoring and endoscopy were performed in 62 patients with GER symptoms and in 42 healthy controls. The results showed that the percentages of the time with pH fluctuations in patients with and without esophagitis and in healthy controls were, on average, 12.65, 9.5 and 2.76% in 24 h, respectively, and the respective percentages of the time with reflux episodes in the same groups in 24 h were, on average, 3.12, 2.04 and 0.18%, respectively. Using a receiver-operating-characteristic curve analysis, less than 6.7% of the time with pH fluctuations and less than 0.1% of the time with reflux episodes were defined as the combined thresholds for physiological versus pathological reflux. The sensitivity of the combined thresholds for the detection of GER patients with and without esophagitis was 96.7 and 90%, respectively, and their specificity for the diagnosis of patients with abnormal GER was 100%. It is concluded that pH fluctuations and reflux episodes, when evaluated together, are more useful for classifying patients with GER and their combined thresholds yield higher diagnostic accuracy in assessing patients with gastroesophageal disease.     

Significantly Reduced Acid Detection at 10 Centimeters Compared to 5 Centimeters above Lower Esophageal Sphincter in Patients with Acid Reflux

Ambulatory pH monitoring of the esophagus is carried out by positioning a pH sensor 5 cm above the lower esophageal sphincter (LES). There are several techniques to locate the LES, and each method has a different margin of error. This work used dual pH sensors to monitor simultaneously at two different levels (5 and 10 cm above the LES) in order to establish the possible magnitude of error that could arise from inaccurate placement of a pH probe. Thirty-four patients with symptoms of gastroesophageal reflux (GER) were studied. They were grouped as 20 patients with pathological reflux (GER group) and 14 patients with physiological reflux, based on a reflux score derived by Johnson and DeMeester for distal esophageal pH monitoring. When the reflux scores were compared, the difference between the two monitoring levels was statistically significant in the GER group ( p < 0.001) but not in the physiological reflux group ( p = 0.09). In the GER group, the difference in the Johnson and DeMeester score accounted for a change in clinical diagnosis in nine of the 20 patients if the pH probe was placed at 10 cm above the upper margin of LES. Proximal reflux episodes (10 cm above LES) were preceded by distal reflux episodes (5 cm above LES) in 97% (878/901) of cases. Accurate probe placement is essential in the diagnosis of GER.     

24-hour esophageal pH-monitoring in children suspected of gastroesophageal reflux disease： Analysis of intraesophageal pH monitoring values recorded in distal and proximal channel at diagnosis

AIM To assess values of 24-h esophageal pH-monitoring parameters with dual-channel probe (distal and proximal channel) in children suspected of gastroesophageal reflux disease (GERD).METHODS 264 children suspected of gastroesophageal reflux (GER) were enrolled in a study (mean age χ = 20.78 ± 17.23 mo). The outcomes of this study,immunoallerrgological tests and positive result of oral food challenge test with a potentially noxious nutrient,enabled to qualify children into particular study groups.RESULTS 32 (12.1%) infants (group 1) had physiological GER diagnosed. Pathological acid GER was confirmed in 138 (52.3%) children. Primary GER was diagnosed in 76 (28.8%) children (group 2) and GER secondary to allergy to cow milk protein and/or other food (CMA/FA) in 62 (23.5%) children (group 3). 32(12.1%) of them had CMA/FA (group 4-reference group),and in remaining 62 (23.5%) children neither GER nor CMA/FA was confirmed (group 5). Mean values of pH monitoring parameters measured in distal and proximal channel were analyzed in individual groups. This analysis showed statistically significant differentiation of mean values in the case of number of episodes of acid GER,episodes of acid GER lasting ＞ 5 min, duration of the longest episode of acid GER in both channels, acid GER index total and supine in proximal channel. Statistically significant differences of mean values among examined groups, especially between group 2 and 3 in the case of total acid GER index (only distal channel) were confirmed.CONCLUSION 24-h esophageal pH monitoring confirmed pathological acid GER in 52.3% of children with typical and atypical symptoms of GERD. The similar pH-monitoring values obtained in group 2 and 3 confirm the necessity of implementation of differential diagnosis for primary vs secondary cause of GER.     

Gastroesophageal reflux induced by white wine: the role of acid clearance and "rereflux"

OBJECTIVES: White wine has been demonstrated to induce gastroesophageal reflux (GER) in healthy people and GER patients. This GER is characterized by reflux episodes of prolonged duration. Our aim was to explore the pathogenesis of the prolonged reflux duration. METHODS: Twelve healthy volunteers received in a randomized order 300 ml of white wine and tap water together with a standardized meal. Esophageal pH and motility were continuously monitored by a glass pH electrode and a strain gauge manometry probe (four measuring points in the esophagus and one in the pharynx to register swallowing) for 90 min after ingestion. Blinded to the ingested beverage, we calculated the fraction of time esophageal pH was <4, the number of reflux episodes and their duration, the swallowing and contraction rate, the contraction amplitude, and the distribution of primary, secondary, simultaneous, and nonpropagated contractions. The motility analysis was separately performed for periods with and without GER. During GER, the time until occurrence of the first contraction, its type, the type of the contraction that raises pH to >4, and the number of peristaltic contractions necessary to raise pH to >4 were also determined. The percentage of GER episodes with simultaneous contractions and failed peristalsis (nontransmitted swallows and nonpropagated contractions) as calculated. The percentage of GER episodes with signs of "rereflux" (further pH drop, common cavity phenomenon in the motility trace) into the acidic esophagus was also determined. The mean reflux duration and the number of peristaltic contractions needed to raise pH to >4 were recalculated by taking the rereflux events into account. RESULTS: White wine significantly increased the fraction of time esophageal pH was <4, reflux frequency, and reflux duration compared to water. During periods without GER, no differences in the motility data were observed between wine and water. During GER, the contraction rate after white wine was significantly lower because of an increase in nontransmitted swallows. The time until occurrence of the first contraction after GER was significantly prolonged after white wine. Primary peristalsis was the main first and clearance contraction type. The percentage of GER episodes with simultaneous contractions and with failed peristalsis was significantly increased with wine. Similarly, the percentage of GER episodes with rereflux was significantly increased. The "corrected" mean reflux duration was still prolonged relative to water, but the difference was no longer significant. The numbers of peristaltic contractions necessary to raise pH to >4, which significantly differed for conventionally defined GER episodes between wine and water, were similar when counted only from onset of the latest rereflux event until pH rose to >4. CONCLUSIONS: The pathogenesis of white wine-induced GER episodes of long duration is 2-fold. First, white wine provokes a disturbed esophageal clearance due to an increase in simultaneous contractions and in failed peristalsis. The second mechanism is the occurrence of repeated reflux events into the esophagus when pH is still acidic from a previous reflux episode.     

Comparison of Simultaneous Esophageal pH Monitoring and Scintigraphy in Infants with Gastroesophageal Reflux

Twenty-nine infants under 1 yr of age were studied by simultaneous esophageal pH monitoring and scintigraphy for evaluation of gastroesophageal reflux (GER). Scintigraphy and pH monitoring were performed for 120 min after infants ingested their usual volume of formula. The number of reflux episodes during six 20-min intervals, as determined by both tests, were recorded. Esophageal pH monitoring was continued for 18–24 h. Sixteen of 29 patients exhibited GER by pH monitoring during the 2-h study. Gastroesophageal reflux occurred in seven of 29 during the first hour and 13 of 29 during the second hour. The mean time of first reflux episode detected by pH monitoring following the feeding was 82.4 ± 49.3 min. In comparison, 28 of 29 patients had GER by scintigraphy during the 2 h. All 28 exhibited GER during the first hour, whereas only 22 of 29 patients exhibited GER during the second hour. The mean time of first episode of reflux by scintigraphy was 3.1 ± 2.7 min. Forty-five percent of all reflux episodes detected by scintigraphy occurred during the first 20 min and 80% were detected during the first hour. In contrast, only 17% of reflux episodes were seen by pH monitoring during the first 20 min and 35% during the first hour; 65% of reflux episodes detected by pH monitoring were during the second hour. There was no correlation between the total number of reflux episodes detected by scintigraphy and 2-h esophageal pH monitoring during the 2-h study period ( r = 0.326; p > 0.1). Overall, to detect reflux, scintigraphy was a more sensitive method than esophageal pH monitoring under the conditions of this study. Scintigraphy selectively detected reflux during the first 60 min postprandially whereas pH monitoring was more likely to detect reflux beyond the first postprandial hour. These observations help to explain the lack of correlation between the two tests.     

Ambulatory Esophageal pH Recording in Gastroesophageal Reflux: Relevance to the Development of Esophagitis

In a group of 60 patients with symptomatic gastroesophageal reflux (GER), we carried out upper gastrointestinal (GI) endoscopy and 24-h ambulatory esophageal pH monitoring to assess the relationship between acid reflux and esophagitis. The results of 24-h pH measurement were compared with those of 15 asymptomatic control subjects who were studied with ambulatory 24-h esophageal pH monitoring only. Thirty-two patients (53.3%) had a normal esophagus macroscopically, and 28 patients (46.7%) had some degree of esophagitis. There was no significant difference between the two groups with and without esophagitis, regarding male:female ratio, age, and duration of symptoms. The group with esophagitis was more symptomatic (p less than 0.001) than the group without, and differed significantly in relation to all pH variables, i.e., number of GER episodes per hour, duration of mucosal exposure to acid (pH less than 4), and number of GER episodes requiring more than 5 min to clear per hour for the upright, supine, and 24-h periods, compared with the control group (p less than 0.001) and the group without esophagitis (p less than 0.001). In the group with esophagitis, comparison of the above pH variables in the upright and supine periods showed significantly higher values in the upright than in the supine period for the total number of reflux episodes per hour (p less than 0.001) and the number of episodes greater than 5 min/h (p less than 0.05). We conclude that the presence of esophagitis is related to both frequency and duration of GER episodes. Our findings also stress the importance of daytime acid exposure in the pathogenesis of esophagitis.     

Association of apnea and nonacid gastroesophageal reflux in infants: Investigations with the intraluminal impedance technique

An association of apnea and gastroesophageal reflux (GER) was proposed previously. However, pH metry as the standard diagnostic tool for GER only measures acid reflux (pH < 4). It is difficult to interpret studies in infants with a presumed association between apnea and GER based on pH metry because the buffering effect of feeding may result in predominantly nonacid GER. The aim of this study was to investigate the temporal association of apnea and GER with the pH-independent intraluminal impedance technique (IMP). Infants with recurrent regurgitation or respiratory symptoms suggestive of apnea were investigated simultaneously with IMP, pH monitoring, and polygraphy. IMP patterns, pH, oronasal flow, and chest wall movement were recorded and analyzed. In 22 infants, 364 GER episodes were recorded by IMP. One hundred and sixty five apneas were documented by visual validation of polygraph records. Forty-nine apneas (29.7%) were associated with GER; 11 (22.4%) of these showed acid reflux (pH < 4). A significant correlation between the time spent apneic and GER was found (P < 0.001). There is marked association between apnea and gastroesophageal reflux in infants. Patients potentially at risk cannot be reliably identified by pH metry. Its exclusive use is therefore not suitable for the detection of all GER-associated apneas in infants. The pH-independent intraluminal impedance technique has proven to be a sensitive diagnostic tool for this approach.     

The Pattern of Gastroesophageal Reflux in Asthmatic Children

The association between gastroesophageal reflux (GER) and asthma is not fortuitous. The objective of our study was to test a group of children with asthma by 24 hr gastroesophageal pH monitoring and to relate the results to the patients' medical history and clinical data. We studied 77 children aged from 39 to 170 months suffering from particularly recurrent and/or therapy-resistant asthma. Medical history data were collected for each patient and included: severity and characteristics of respiratory symptoms; presence, if any, of allergy; presence, if any, of GER-related symptoms; and presence, if any, of esophagitis-related symptoms. Esophageal pH was measured by 24 hr computerized monitoring of the main measures in all patients. Forty-seven children were also examined by gastroesophageal endoscopy. The prevalence of GER was 61% on the basis of the reflux index (cutoff: 4.2%). Gastroesophageal reflux in these asthmatic children was characterized mainly by short-lasting daytime episodes. The patients tended to present GER mainly associated with vomiting but not with signs and symptoms of esophagitis. The short-lasting nature of the reflux episodes demonstrates good esophageal clearance. The time of onset of respiratory symptoms (day/night) was not associated with any particular type of GER, the severity of which tends to be proportional to the seriousness of the asthma. No correlation was found between GER and allergy. No statistically significant differences were found in clinical or medical history findings between patients with pathologic and nonpathologic GER.