The importance of pH reflux monitoring test for the management of low‐grade esophagitis in Chinese patients

Abstract

Background and aims Low‐grade esophagitis (grade A and B) are no longer believed as confirmatory evidence of gastroesophageal reflux disease, but there were no data about the association of low‐grade esophagitis with pathological acid reflux (PAR) in China. This study aimed to summarize the proportion of PAR in the patients with low‐grade esophagitis and to explore the differential factors between low‐grade esophagitis patients with and without PAR. Methods Database of the patients accepted 24‐hour pH monitoring in the motility laboratory of a tertiary center was retrospectively searched, and the patients were diagnosed as low‐grade esophagitis before the procedure was recruited. The demographics, symptoms and high‐resolution manometry and pH monitoring parameters were compared between the patients with pathological and physiological acid reflux and between patients with grade A and B esophagitis. Results About 24% of grade A and 55% of grade B esophagitis patients had pathological acid reflux. The demographics, symptoms, and almost all high‐resolution manometry findings were similar in patients with pathological and physiological acid reflux. About two‐thirds of the participants with physiological acid reflux reported symptom improvement after PPI administration. All participants with PPI‐resistant symptoms were with physiological acid reflux. Conclusion The proportion of PAR in low‐grade esophagitis is not high. For patients with low‐grade esophagitis in China, especially the patients with grade A esophagitis, regardless of symptom change, reflux monitoring is possibly needed for the patients whose esophageal mucosa break is not improved after 8 weeks of PPI treatment.

Esophageal symptoms versus epigastric symptoms: Relevance for diagnosis of gastroesophageal reflux disease

“…8 Furthermore, several studies from China have revealed that GERD is not very prevalent and the acid burden is quite low in Chinese population, which is different from the situation in Western countries. [25][26][27] We also found a fairly low prevalence of RE and pathological AET of only 21%-36% in patients with typical esophageal symptoms. However, in spite of this low prevalence, these patients' PPI response rate reached 46%-68%.…”

“…Our previous study showed that over 60% of heartburn symptoms were ascribed to functional esophageal disorders instead of GERD in southern China 8 . Furthermore, several studies from China have revealed that GERD is not very prevalent and the acid burden is quite low in Chinese population, which is different from the situation in Western countries 25‐27 . We also found a fairly low prevalence of RE and pathological AET of only 21%‐36% in patients with typical esophageal symptoms.…”

The prevalence of gastroesophageal reflux disease and laryngopharyngeal reflux in patients with dysphagia after radiotherapy for nasopharyngeal carcinoma

“…90,91 However, the proportion of asymptomatic patients with reflux esophagitis is considerable. 92 Since there is a lack of data regarding GERD and LPR in post-irradiated patients with head and neck cancer, and the pattern of such conditions, it would be worthwhile to further investigate whether any such association exists in our patients.…”

Mean Nocturnal Baseline Impedance and Post-reflux Swallow-induced Peristaltic Wave Index Could Identify Gastroesophageal Reflux Disease but pH-Impedance Metrics Alone Might Not Correlate With Proton Pump Inhibitor Response in Chinese Patients With Typical Reflux Symptoms

“…Together with 2 Chinese studies from other centers (with 28 and 38 patients with AET between 4-6% respectively) 5,6 and the 95% CI of the AET of Asian asymptomatic individuals (2.7-3.9%) from the 2020 Seoul consensus of the management of GERD, 4 it is reasonable to set 4% as the threshold to define pathological acid reflux for Chinese patients. Indeed, based on the expert's experience and the limited published evidence, 6,23 the clinical guideline for esophageal ambulatory reflux monitoring in adults released in 2021 by the Gastrointestinal Motility Group, Chinese Society of Gastroenterology made a statement that pathological reflux is considered when AET ≥ 4%. 24 Impedance parameters were compared between patients with AET ≥ 4% and AET < 4%, and we found the total reflux episodes, weakly acid reflux episodes, alkaline reflux episodes, and positive SAP are similar.…”