To determine the relationship between histologic grading of reflux oesophagitis and both intra-oesophageal acid exposure and intragastric acidity.
Endoscopy and simultaneous 24-h recording of intra-oesophageal and intragastric pH.
Eighty-one patients with symptoms strongly suggesting gastro-oesophageal reflux disease; intra-oesophageal and intragastric pH was also recorded in 16 controls. Results: Reflux oesophagitis was found in 71 patients and was graded as follows: mild-A (15 patients), mild-B (26 patients), moderate (16 patients) and severe (14 patients). Abnormal gastro-oesophageal reflux was found in the remaining 10 patients, although there was no histological evidence of reflux oesophagitis. There was no statistical difference in the oesophageal acid exposure or in the number of gastro-oesophageal reflux episodes lasting ≥5 min when the reflux oesophagitis groups were compared. Intragastric acidity, median intragastric pH and percentage of intragastric pH <2 were significantly higher in patients with severe reflux oesophagitis compared with the other reflux oesophagitis groups.
Endoscopy and histology of the oesophagus seem to be the most valuable diagnostic tools in children with symptoms suggesting gastro-oesophageal reflux disease. Furthermore, the severity of oesophagitis appears to be related more to the potency of refluxed material than to oesophageal acid exposure.
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