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Symptomatic Acid Reflux Occurs Earlier and Associated with Faster Velocity Reflux Than Symptomatic Non-Acid Reflux

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Agrawal, Amit MD; Hila, Amine MD; Blonski, Wojciech MD; Tutuian, Radu MD; Castell, Donald O. MD

American Journal of Gastroenterology: September 2006 - Volume 101 - Issue - p S50
Abstracts: ESOPHAGUS
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Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC.

Purpose: 24 hour multichannel intraluminal impedance and pH (MII-pH) esophageal monitoring allows detection of both acid and non-acid gastroesophageal reflux (GER) episodes. The MII-pH catheter contains 6 impedance segments placed 3, 5, 7, 9, 15, and 17 cm above the LES, plus a pH electrode at 5 cm allowing detection of cephalad progression of refluxate. Patients with acid and non-acid reflux exhibit typical and atypical symptoms often within 5 minutes of a reflux episode.

Aim: To compare the velocity of reflux and timing of symptoms after reflux episodes in patients with acid and non-acid reflux.

Methods: Review of 78 MII-pH tracings (42 females; mean age 40; range 1– 85 years) either on (53 pts) or off (25 pts) acid suppression therapy. Typical (heartburn, regurgitation) and atypical symptoms (cough) with acid or non-acid reflux episodes detected by impedance were analyzed. Symptoms were considered positive with acid reflux if there was a pH drop < 4 and an MII detected reflux episode and with non-acid reflux if pH > 4 and an MII detected reflux episode. The timing of symptom after each reflux episode and reflux velocity were recorded. In addition, the percentage of symptoms occurring within the first 60 seconds, 60–120 seconds, 120–180 seconds, 180–240 seconds, and 240 seconds–300 seconds was also calculated. Table 1 and 2 below summarize the results.

Table 1

Table 1

Table 2

Table 2

Results: Summarized in tables 1 and 2.

Conclusions: Patients with acid reflux are likely to experience symptoms earlier and have faster velocities than with non-acid reflux. In addition, patients experience regurgitation with acid or non-acid reflux earlier and have faster velocities versus patients with heartburn and cough and acid or non-acid reflux. Patients are likely to experience regurgitation, heartburn, and cough with acid reflux and regurgitation with non-acid reflux within the first two minutes.

© The American College of Gastroenterology 2006. All Rights Reserved.