Characteristics of symptomatic reflux episodes on Acid suppressive therapy

Am J Gastroenterol. 2008 May;103(5):1090-6. doi: 10.1111/j.1572-0241.2008.01791.x. Epub 2008 Apr 28.

Abstract

Background: Persistent symptoms on acid suppressive therapy are due to either acid or nonacid gastroesophageal reflux (GER) episodes or are not related to reflux.

Aim: To compare physical and chemical characteristics of GER episodes associated with symptoms in patients on acid suppressive therapy.

Methods: Patients with persistent symptoms on acid suppressive therapy underwent combined impedance-pH monitoring. Reflux episodes were classified as acid if nadir pH was <4.0, and nonacid if it remained at >/=4.0, separated into liquid-only or mixed (liquid-gas), and considered to reach the proximal esophagus if liquid was present 15 cm above the lower esophageal sphincter (LES). Reflux episodes were considered symptomatic if patients recorded a symptom within 5 min after the reflux episode. Risk factors of symptomatic reflux episodes were identified using multivariable generalized estimating equations (GEEs).

Results: One hundred twenty patients (85 women, median age 54 yr, range 18-85 yr) recorded 3,547 reflux episodes (84.3% nonacid, 50.6% mixed), of which 468 (13.2%) were symptomatic. Based on multivariable GEE analysis with episode-level symptom status (symptomatic vs nonsymptomatic) as the outcome variable, reflux episode acidity was not significantly associated with symptoms (P= 0.40). Mixed reflux episodes were significantly associated with symptoms relative to liquid-only episodes (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.19-1.87, P= 0.0005), as were reflux episodes reaching the proximal esophagus compared with those reaching the distal esophagus only (OR 1.28, 95% CI 1.06-1.55, P= 0.012).

Conclusion: The majority of reflux episodes on acid suppressive therapy are asymptomatic. Reflux episodes extending proximally and having a mixed (liquid-gas) composition are significantly associated with symptoms, irrespective of whether pH is acid (<4) or nonacid (>/=4).

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Drug Therapy, Combination
  • Female
  • Gastric Acidity Determination*
  • Gastroesophageal Reflux / diagnosis
  • Gastroesophageal Reflux / drug therapy*
  • Gastroesophageal Reflux / etiology
  • Histamine H2 Antagonists / therapeutic use
  • Humans
  • Hydrogen-Ion Concentration
  • Male
  • Middle Aged
  • Proton Pump Inhibitors / therapeutic use*
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome

Substances

  • Histamine H2 Antagonists
  • Proton Pump Inhibitors