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Digestion 2008The fundamental abnormality in gastroesophageal reflux disease is exposure of the esophageal epithelium to acidic gastric contents, resulting in histopathologic injury... (Review)
Review
The fundamental abnormality in gastroesophageal reflux disease is exposure of the esophageal epithelium to acidic gastric contents, resulting in histopathologic injury and/or symptoms. With increasing understanding of gastroesophageal reflux disease, non-erosive reflux disease (NERD) is found to account for >50% of cases involving gastroesophageal reflux. There is a good correlation between esophageal acid exposure (EAE) and endoscopic changes. Duration of EAE correlates with severity of erosive esophagitis (EE), and the number of prolonged acid reflux episodes and esophageal exposure to acid and pepsin is increased in more severe reflux. However, there is no convincing evidence to support a significant difference in the acid secretory capacity between patients with NERD or EE. Although acid reflux gives rise to similar symptoms in both NERD and EE patients, the underlying mechanism of acid injury may be different. Dilated intercellular spaces may be responsible for the enhanced perception of proximal acid reflux and dilated intercellular spaces are a feature of NERD patients, irrespective of EAE, and can be considered an objective, structural marker of reflux symptoms. Three different mechanisms have been proposed to explain the occurrence of heartburn in endoscopy-negative patients: esophageal visceral hypersensitivity, sustained esophageal contractions, and abnormal tissue resistance. Impaired esophageal mucosal resistance or increased sensitivity, even to small amounts of acid reflux, plays a key role in the pathophysiology of NERD. Moreover, hyperalgesia may be a predominant mechanism in eliciting symptoms in NERD patients. Increasingly seen are patients with a poor response to acid suppression treatment. Moreover, even double proton pump inhibitor dosing does not completely inhibit gastric acid secretion and relieve all symptoms. Thus, current definitions of acid reflux require review to increase the sensitivity to determine the frequency and implication of short periods of acidity in the esophagus. Analysis such as analysis of the area under the H(+) activity time curve is one alternative approach for evaluating acid secretion. The precise role of acid in NERD needs further clarification.
Topics: Esophageal pH Monitoring; Gastric Acid; Gastroesophageal Reflux; Heartburn; Humans; Intestinal Mucosa; Proton Pump Inhibitors; Severity of Illness Index
PubMed: 18832838
DOI: 10.1159/000151253 -
General Dentistry 2009Dental erosion can be difficult to detect, especially in the early stages when lesions are subtle and can be easily overlooked. Patients often are not aware of erosion... (Review)
Review
Dental erosion can be difficult to detect, especially in the early stages when lesions are subtle and can be easily overlooked. Patients often are not aware of erosion until the dentition has sustained severe damage that requires extensive and expensive dental rehabilitation. The pH of stomach acid is much lower than the critical pH of enamel dissolution; therefore, reflux of stomach contents into the oral cavity over an extended period of time can cause severe loss of tooth structure. Dental treatment for reflux-induced erosion should focus not only on appropriate restoration but also on all available preventive measures, such as neutralization of acid and remineralization or strengthening of enamel against acid attack. Dentists must maintain a high degree of suspicion for reflux-induced erosion whenever a patient displays symptoms of acid reflux disease or a pattern of erosion that suggests an intrinsic source of acid exposure.
Topics: Dental Enamel Solubility; Gastric Acid; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Protective Agents; Sodium Fluoride; Tooth Erosion; Tooth Remineralization
PubMed: 19552365
DOI: No ID Found -
European Journal of Gastroenterology &... Sep 2004In patients with gastro-oesophageal reflux disease (GORD), oesophageal symptoms and mucosal damage traditionally are related to acid-reflux episodes with pH lower than... (Review)
Review
In patients with gastro-oesophageal reflux disease (GORD), oesophageal symptoms and mucosal damage traditionally are related to acid-reflux episodes with pH lower than 4. Oesophageal or extra-oesophageal symptoms of GORD may also be associated with less acidic reflux (pH 4-7). New methodologies have evolved to complement pH monitoring for characterisation of less acidic gastro-oesophageal reflux. This review will focus on definition, detection, pathophysiology and symptom association of weakly acidic and non-acid reflux, in both adult and paediatric populations.
Topics: Adult; Child; Diagnostic Techniques, Digestive System; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Prevalence
PubMed: 15316403
DOI: 10.1097/00042737-200409000-00002 -
Journal of Pediatric Gastroenterology... Feb 2016The relation between tooth erosion (TE) and gastroesophageal reflux in children has not been clearly established, and there are no studies to determine the relation with...
OBJECTIVES
The relation between tooth erosion (TE) and gastroesophageal reflux in children has not been clearly established, and there are no studies to determine the relation with refluxate height, nonacid reflux, and erosions. The aim of this study was to determine the relation between TE and acid and nonacid gastroesophageal refluxes measured using combined pH and multichannel intraluminal impedance (pH-MII).
METHODS
We conducted a prospective cohort study of children presenting for pH-MII testing. Once informed consent was obtained, patients completed questionnaires about their reflux symptoms and diet, and then underwent pH-MII catheter placement and a dental examination. The Keels-Coffield erosion index was used to score the extent and severity of TE. Reflux parameters of patients with and without TE were compared using Student t test and correlations were performed using Spearman correlations.
RESULTS
A total of 27 patients participated in the study, all of whom were on acid suppression at the time of pH-MII testing. Of the 27 patients, 10 (37%) had TE. There were significant positive correlations between acid reflux episodes (r = 0.44, P = 0.02), the percentage of time that acid reflux was present in the distal esophagus (r = 0.44, P = 0.02), and reflux index (r = 0.54, P = 0.004) with the number of TE in a given patient. The percentage of time that acid reflux was present in the proximal esophagus was positively correlated with the number of teeth erosions per patient with borderline significance (r = 0.38, P = 0.05).
CONCLUSIONS
There was a positive correlation between acid reflux parameters and TE. Acid, rather than nonacid reflux, seems to have a significant role in the pathogenesis of TE.
Topics: Adolescent; Child; Child, Preschool; Electric Impedance; Esophageal pH Monitoring; Esophagus; Female; Gastric Acid; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Male; Prospective Studies; Severity of Illness Index; Surveys and Questionnaires; Tooth; Tooth Erosion
PubMed: 26230904
DOI: 10.1097/MPG.0000000000000927 -
Otolaryngology--head and Neck Surgery :... Oct 2012To identify and appraise the evidence for an association between laryngomalacia (LM) and acid reflux through a systematic review of the existing literature. (Review)
Review
OBJECTIVE
To identify and appraise the evidence for an association between laryngomalacia (LM) and acid reflux through a systematic review of the existing literature.
DATA SOURCES
MEDLINE, EMBASE, the Cochrane Library, Google Scholar, and collected additional publications cited in bibliographies.
REVIEW METHODS
Literature search by both authors with structured criteria to select studies evaluated for systematic review. The Oxford Centre for Evidence-Based Medicine (CEBM) guidelines were applied to assess study quality of evidence.
RESULTS
Twenty-seven studies, representing 1295 neonates with LM, were included. Levels of evidence varied from CEBM level 2a (n = 1) to 4 (n = 23). Although reflux definitions were diverse, overall reflux prevalence in this group was 59% (pooled odds ratio [OR] of 4 controlled studies = 1.15, P = .67). Further evidence supporting an association between reflux and LM included the ubiquity of acid reflux using dual-probe pH monitoring in children with LM (2 studies; n = 84), the increased prevalence of reflux in severe as compared with mild LM (3 studies; n = 237; pooled OR = 9.86, P < .0001), case series and reports of LM improvement with antireflux therapy (6 studies; n = 275), and histological evidence of reflux-related laryngeal inflammation in children with LM (2 studies; n = 18).
CONCLUSION
The literature shows a coexistence between acid reflux and LM, but the evidence for a causal association is limited. In view of the widespread use of antireflux treatment in LM, a randomized controlled trial of antireflux medication vs placebo appears justified.
Topics: Evidence-Based Medicine; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Incidence; Infant, Newborn; Laryngomalacia; Prevalence; Severity of Illness Index
PubMed: 22745201
DOI: 10.1177/0194599812452833 -
Journal of Digestive Diseases Feb 2019To explore the correlation between reflux disease and abnormal esophageal motility in patients with gastroesophageal reflux disease (GERD).
OBJECTIVE
To explore the correlation between reflux disease and abnormal esophageal motility in patients with gastroesophageal reflux disease (GERD).
METHODS
Participants (patients with GERD and controls) who underwent 24-h impedance-pH monitoring (MII-pH monitoring) and high-resolution manometry between January 2012 and February 2017 were retrospectively studied. The patients were divided into two groups (acid reflux and nonacid reflux) based on their MII-pH monitoring data. Reflux episodes, endoscopic findings, and esophageal dynamic parameters were assessed and compared.
RESULTS
A total of 142 patients were included (acid reflux [n = 58], nonacid reflux [n = 60], control group [n = 24]). There were more patients with esophagitis and more severe esophageal mucosal injury in the acid reflux group than in the nonacid reflux group. The acid reflux group had reduced lower esophageal sphincter (LES) basal pressure, shorter LES length, lower esophageal pressure and distal contractile integral index than the nonacid reflux group. Patients in the acid reflux group had more large breaks and a higher incidence of type II and III esophagogastric junction morphology than those in the nonacid reflux group. Acid exposure time, the incidence of long-term acid reflux, recumbent acid reflux, and the incidence of acid and nonacid reflux had a significant negative correlation with esophageal body motility or LES function.
CONCLUSION
This study suggests that an increase in esophageal acid exposure is correlated with an increase in esophageal dysmotility in patients with GERD.
Topics: Adult; Aged; Esophageal Motility Disorders; Esophageal pH Monitoring; Esophagus; Female; Gastroesophageal Reflux; Humans; Male; Manometry; Middle Aged; Retrospective Studies
PubMed: 30629802
DOI: 10.1111/1751-2980.12703 -
Alimentary Pharmacology & Therapeutics Aug 2010The importance of weakly acidic and weakly alkaline reflux in gastro-oesophageal reflux disease (GERD) is gaining recognition. (Review)
Review
BACKGROUND
The importance of weakly acidic and weakly alkaline reflux in gastro-oesophageal reflux disease (GERD) is gaining recognition.
AIM
To quantify the proportions of reflux episodes that are acidic (pH <4), weakly acidic (pH 4-7) and weakly alkaline (pH >7) in adult patients with GERD, and to evaluate their correlation with symptoms.
METHODS
Studies were identified by systematic PubMed and Embase searches. Data are presented as sample-size weighted means and 95% confidence intervals.
RESULTS
In patients with GERD taking a proton pump inhibitor (PPI), 80% (76-84%) of reflux episodes were weakly acidic or weakly alkaline and 83% (78-88%) of reflux symptom episodes were associated with weakly acidic or weakly alkaline reflux episodes. In patients with GERD not taking a PPI, 63% (59-67%) of reflux episodes were acidic and 72% (57-87%) of reflux symptom episodes were associated with acid reflux episodes. Six studies presented data separately for weakly alkaline reflux, which accounted for <5% of all reflux episodes, both on and off PPI therapy.
CONCLUSIONS
Weakly acidic reflux underlies the majority of reflux episodes in patients with GERD on PPI therapy, and is the main cause of reflux symptoms occurring despite PPI therapy.
Topics: Adult; Female; Gastric Acidity Determination; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Male; Proton Pump Inhibitors
PubMed: 20491749
DOI: 10.1111/j.1365-2036.2010.04358.x -
The New England Journal of Medicine Apr 2009
Topics: Asthma; Gastroesophageal Reflux; Humans; Omeprazole; Proton Pump Inhibitors; Treatment Failure
PubMed: 19357411
DOI: 10.1056/NEJMe0900117 -
Transactions of the American Clinical... 2005Multichannel intraluminal impedance (MII) is a new technique for evaluating esophageal function and gastroesophageal reflux. This technique depends on changes in... (Review)
Review
Multichannel intraluminal impedance (MII) is a new technique for evaluating esophageal function and gastroesophageal reflux. This technique depends on changes in resistance to alternating current between two metal electrodes produced by the presence of liquid or gas bolus inside the esophageal lumen. Combined multichannel intraluminal impedance and manometry (MII-EM) provides simultaneous information on intraluminal pressure changes and bolus movement whereas combined multichannel intraluminal impedance and pH (MII-pH) allows detection of gastroesophageal reflux (GER) episodes irrespective of their pH values (i.e. acid and non-acid reflux). Combined MII-pH testing presents a new paradigm for reflux testing. In MII-pH studies reflux events are no longer primarily detected by pH. Refluxate presence, distribution and clearing is primarily detected by MII and simply characterized as acid or non-acid based on pH change and as liquid, gas or mixed based on MII. MII determines refluxate clearance time while pH measures acid clearance time. MII-pH shows promise to become an important clinical tool, particularly to assess GER in the postprandial period and in patients with persistent symptoms on acid suppression therapy.
Topics: Adult; Algorithms; Esophagogastric Junction; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Infant; Plethysmography, Impedance
PubMed: 16555624
DOI: No ID Found -
The American Journal of Gastroenterology Feb 2009
Review
Topics: Catheterization; Electric Impedance; Esophageal pH Monitoring; Gastric Acidity Determination; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration
PubMed: 19190606
DOI: 10.1038/ajg.2008.23