Purpose: Many pts with GERD following PPI therapy continue to have sx. Because the etiology of their sx is not clearly known, adequate treatment is not possible. We evaluated 247 pts for their sx correlating it with 24 hr pH and motility findings.
Methods: Major sx were heartburn and regurgitation in 112 pts (A), atypical chest pain in 29 (B), dysphagia not related to achalasia and diffuse esophageal spasm in 28 (C), heartburn plus atypical chest pain in 66 (D), and combination of heartburn, atypical chest pain and dysphagia in 9 (E).
Results: On 24-hr pH recording, A pts had significant acid reflux, alkaline reflux, combined acid and alkaline reflux and no significant acid or alkaline reflux in 33%, 42% 11%, 14%; B pts in 17%, 41%, 8%,34%; C pts in 28%, 43%, 8%, 21%, D pts in 21%, 45%, 7%, 27% and E pts in 22%, 66%, 0%, 11% respectively. Esophageal wave activity was greater in E pts (>D>B>A>C; the common sx in E, D, B was atypical chest pain).% peristaltic activity was lowest in C pts (<B<D = E = A; common sx C and B were chest pain and dysphagia).% simultaneous waves was highest in C pts (>B>E>D>A; common sx in C, B and E were chest pain and dysphagia).% isolated contractions were elevated in C>A>B>E>D pts. Median amplitude of contractions were lowest in D and E (common sx were chest pain and heartburn). Contractions were most prolonged in the chest pain group (B>D>A>C>E) and percent repetitive waves were highest in D>C>B>E>A. (Common sx in C, D, B were atypical chest pain). Subgroup analysis of heartburn pts showed significantly decreased # of contractions and significant increase in median amplitude of waves in the distal esophagus (p < 0.001) in the high alkaline reflux group.
Conclusions: We conclude that alkaline reflux is the most common reflux pattern in all sx groups and is associated with increased amplitude of waves in the distal esophagus. Acid reflux and combined reflux occurred most in A pts, whereas B pts has mostly no reflux. Esophageal contractility is most preserved when atypical chest pain was present as a major sx. Peristaltic activity is least present in C pts with increased isolated and simultaneous contractions; followed by D pts. In view of various reflux patterns in all sx groups, we conclude that not the reflux pattern, but the motility changes, characterize these sx.