Impact of Measurement of Esophageal Acid Exposure Close to the Gastroesophageal Junction on Diagnostic Accuracy and Event-Symptom Correlation

Bansal, Ajay; Wani, Sachin; Rastogi, Amit; Rastogi, Keith; Goyal, Amit; Hall, Sandy B.; Singh, Vikas; Higbee, April D.; Sharma, Prateek

doi:10.1038/ajg.2009.506

Cited by 17 publications

(14 citation statements)

References 27 publications

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“…The 4‐electrode pH monitoring system described in this study can record simultaneously the pH of the distal esophagus, the upper border of the LES, the gastric fundus, and the gastric body. The site of the electrode in the upper border of the LES in this study was quite close to the monitoring site for short‐segment reflux . In patients with GERD, simultaneous monitoring of the pH in the upper border of the LES detected short‐segment reflux in 80% of the patients with normal EAE in the distal esophagus, indicating that synchronous pH monitoring of the very distal esophagus may enhance the diagnostic yield of acid exposure in patients with GERD.…”

Section: Discussionsupporting

confidence: 61%

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Effect of high‐fat, standard, and functional food meals on esophageal and gastric pH in patients with gastroesophageal reflux disease and healthy subjects

Fan

Hou

Sun

et al. 2018

J of Digest Diseases

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Objectives To investigate the effects of different test meals on esophageal and intragastric pH in patients with gastroesophageal reflux disease (GERD) and healthy subjects and to demonstrate the relationship between esophageal acid exposure (EAE) and gastric pH. Methods We enrolled patients with reflux esophagitis (RE; n = 15), nonerosive reflux disease (NERD; n = 12) and healthy subjects (n = 10). Four pH electrodes were used to monitor the pH of the distal esophagus, upper border of the lower esophageal sphincter, gastric fundus, and gastric body for 26 hours. Isocaloric and isovolumetric high‐fat, standard, and functional meals were supplied randomly to the participants. The EAE and gastric acidity of each meal in fasting and postprandial states were compared. Results High‐fat meals significantly increased postprandial EAE in patients with RE and NERD. EAE was higher after a high‐fat meal than after a standard or functional food meals at the fourth hour postprandially in patients with RE (P < 0.05). Patients with NERD reported fewer symptoms after a functional food meal than after high‐fat and standard meals (0 [interquartile range {IQR} 0–1] vs 1 [IQR 0–2] vs 3 [IQR 1–4], P = 0.014). Compared with high‐fat and standard meals, functional food meal significantly decreased gastric acidity in patients with RE. EAE was significantly related to gastric acidity in patients with RE. Conclusions High‐fat meals increased EAE in patients with RE and NERD. Functional food could serve as adjuvant therapy in GERD patients. EAE was related to gastric acidity in RE patients.

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Section: Discussionsupporting

confidence: 61%

“…Abnormal EAE in the upper border of the LES was defined as the percentage of the time when the pH <4 (over 10.6% according to the studies of Wenner et al . and Bansal et al …”

Section: Methodsmentioning

confidence: 99%

Effect of high‐fat, standard, and functional food meals on esophageal and gastric pH in patients with gastroesophageal reflux disease and healthy subjects

Fan

Hou

Sun

et al. 2018

J of Digest Diseases

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“…Numerous case-control studies have shown that individuals with GERD are 6–8 times more likely to have BE, and the propensity to develop BE increases with more severe symptoms (see Table 1) 27–29 Longer duration of GERD may create an environment conducive to the development of BE 30 However, the presence of reflux symptoms is neither sensitive nor specific for pathologic acid reflux 31, 32 , and indeed symptom severity does not correlate well with BE risk. 33, 34 Some work has suggested that patients with more significant symptoms may be less likely to have BE, 35 perhaps because of impaired acid sensitivity of the columnar metaplasia compared to normal squamous epithelium.…”

Section: Epidemiology Of Barrett’s Esophagusmentioning

confidence: 99%

Epidemiology of Barrett’s Esophagus and Esophageal Adenocarcinoma

Runge

Abrams

Shaheen

2015

Gastroenterology Clinics of North America

228

156

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Barrett’s esophagus (BE) is a common condition, and is the precursor to esophageal adenocarcinoma, a disease with increasing burden in the western world, especially in Caucasian males. The incidence of BE increased dramatically during the late-20th century and incidence estimates continue to increase, with a prominent male:female ratio. The prevalence is between 0.5 – 2.0 percent. A number of anthropomorphic and behavioral risk factors exist for BE including obesity and tobacco smoking, but GERD is the strongest risk factor, and the risk is more pronounced with long-standing GERD. Esophageal adenocarcinoma (EAC) is the most common form of esophageal cancer in the U.S. Risk factors include GERD, tobacco smoking, and obesity, while NSAIDs and statins may be protective. A major factor predicting progression from non-dysplastic BE to EAC is the presence of dysplastic changes seen on esophageal histology, although a number of issues limit the utility of dysplasia as a marker for disease. Length of the involved BE segment is another risk for progression to high-grade dysplasia and cancer. Biomarkers have shown promise, but none are approved for clinical use.

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“…In these studies, healthy asymptomatic patients demonstrated good tolerability. 15,16 Dual distal deployment reinforced evidence that a gradient of pH and percentage time pH \4 exists in asymptomatic volunteers. The degree of reflux and percentage time pH \4 decreases at sites farther from the SCJ.…”

Section: Discussionmentioning

confidence: 88%