ABSTRACT
Objective: To determine the characteristics of postprandial proximal gastric acid pockets (PPGAPs) and their association with gastroesophageal acid reflux in patients with Barrett’s esophagus (BE). Methods: Fifteen patients with BE (defined by columnar lined esophagus of ≥1 cm) and 15 healthy individuals that were matched for age, gender, and body mass index, were recruited. The fasting intragastric pH and the appearance time, length, lowest pH, and mean pH of the PPGAP were determined using a single pH electrode pull-through experiment. For BE patients, a gastroesophageal reflux disease questionnaire (GerdQ) was completed and esophageal 24-h pH monitoring was carried out. Results: The PPGAP was significantly longer (5 (3, 5) cm vs. 2 (1, 2) cm) and the lowest pH (1.1 (0.8, 1.5) vs. 1.6 (1.4, 1.9)) was significantly lower in patients with short-segment BE than in healthy individuals. The PPGAP started to appear proximally from the gastroesophageal pH step-up point to the esophageal lumen. The acidity of the PPGAP was higher in the distal segment than in the proximal segment. In short-segment BE patients, there were significant correlations between the acidity and the appearance time and length of the PPGAP. The length and acidity of the PPGAP were positively associated with gastroesophageal acid reflux episodes. The acidity of the PPGAP was associated with the DeMeester scores, the GerdQ scores, and the fasting intragastric pH. Conclusions: In patients with short-segment BE, a PPGAP is commonly seen. Its length and acidity of PPGAP are associated with gastroesophageal acid reflux, the DeMeester score, and the GerdQ score in patients with short-segment BE.
ABSTRACT
OBJECTIVE@#To determine the characteristics of postprandial proximal gastric acid pockets (PPGAPs) and their association with gastroesophageal acid reflux in patients with Barrett's esophagus (BE).@*METHODS@#Fifteen patients with BE (defined by columnar lined esophagus of ≥1 cm) and 15 healthy individuals that were matched for age, gender, and body mass index, were recruited. The fasting intragastric pH and the appearance time, length, lowest pH, and mean pH of the PPGAP were determined using a single pH electrode pull-through experiment. For BE patients, a gastroesophageal reflux disease questionnaire (GerdQ) was completed and esophageal 24-h pH monitoring was carried out.@*RESULTS@#The PPGAP was significantly longer (5 (3, 5) cm vs. 2 (1, 2) cm) and the lowest pH (1.1 (0.8, 1.5) vs. 1.6 (1.4, 1.9)) was significantly lower in patients with short-segment BE than in healthy individuals. The PPGAP started to appear proximally from the gastroesophageal pH step-up point to the esophageal lumen. The acidity of the PPGAP was higher in the distal segment than in the proximal segment. In short-segment BE patients, there were significant correlations between the acidity and the appearance time and length of the PPGAP. The length and acidity of the PPGAP were positively associated with gastroesophageal acid reflux episodes. The acidity of the PPGAP was associated with the DeMeester scores, the GerdQ scores, and the fasting intragastric pH.@*CONCLUSIONS@#In patients with short-segment BE, a PPGAP is commonly seen. Its length and acidity of PPGAP are associated with gastroesophageal acid reflux, the DeMeester score, and the GerdQ score in patients with short-segment BE.
ABSTRACT
Background:Postprandial proximal gastric acid pocket (PPGAP)is an unbuffered layer of high acidity in the proximal stomach postprandially. It is considered to play an important role in gastroesophageal reflux disease (GERD). Aims:To investigate the effect of PPGAP in GERD. Methods:Sixty outpatients with GERD,including 20 non-erosive reflux disease (NERD),20 mild reflux esophagitis (RE)and 20 moderate-to-severe RE from Mar. 2014 to Dec. 2016 at the Second Affiliated Hospital of Xi'an Jiaotong University were enrolled. Twenty healthy volunteers were served as controls. All the subjects underwent a high-resolution esophageal manometry in fasting state to identify the location of the lower border of the lower esophageal sphincter (LBLES). Then a station pull-through pH monitoring was performed from 5 cm below the LBLES (stomach)to the esophagus in increments of 1 cm in fasting state and repeated after a standardized meal to detect the PPGAP. Results:PPGAP was identified in all the subjects. There were no significant differences in appearing time of PPGAP among healthy volunteers and different subtypes of GERD (P ＞0.05 ). Compared with the healthy volunteers,the disappearing time of PPGAP was significantly later and the lasting time was significantly longer in patients with NERD,mild RE and moderate-to-severe RE (P＜0.05);meanwhile,the length of PPGAP was enlarged and the nadir pH and mean pH were decreased in NERD,mild RE and moderate-to-severe RE (P＜0.05). When comparison was made between different subtypes of GERD,no significant differences were observed in above-mentioned parameters (P＞0.05). Conclusions:PPGAP is present generally in normal individuals and GERD patients,and is lasting longer, more acidic and enlarged in length in GERD patients than in normal individuals. PPGAP may be the reservoir from which acid reflux events originate and contributes to the development of GERD.
ABSTRACT
Objective To explore the relationship between acid pocket and acid reflux in gastroesophageal reflux disease (GERD).Methods From March 2011 to January 2012,29 patients with GERD were enrolled and nine healthy individuals were set as control.All objects of this study accepted esophageal manometry test,acid pocket test,test of the occurrence time of acid pocket and ambulatory 24 hours pH monitoring.The t-test was performed for comparison between two groups.The relationship between the incidence of GERD and acid pocket was analyzed by Logistic regression analysis.Pearson correlation analysis was used for correlation analysis.Results The percentage of acid pocket in GERD group and control group was 58.6％ (17/29) and 5/9,respectively,and the difference was not statistically significantly (P＞0.05).The duration time of acid pocket was (56.3±44.7) minutes in GERD group which was longer than that of control group ((16.0±8.2) minutes) and the difference was statistically significant (t=1.970,P＜0.01).There was no statistical significance in the average pH value of acid pocket between GERD group with acid pocket (2.8 ± 1.3) and that of control group with acid pocket (1.9±0.5,P＞0.05).The duration time of acid pocket was correlated with the longest reflux time in GERD group with acid pocket (r=0.550,P＜0.01).The peak velocity of esophageal motility in GERD group ((3.3±0.6) cm/s) was lower than that of control group ((5.0±4.1) cm/s) and the difference was statistically significant (t=-1.354,P＜0.05).The peak velocity of esophageal motility in GERD group with acid pocket ((3.2±0.6) cm/s) was lower than that of control group with acid pocket ((7.2± 6.3) cm/s) and the difference was statistically significant (t=-2.693,P＜0.05).Conclusions The duration time of acid pocket in GERD is correlated with the time of acid reflux.Esophageal dysmotility may be related with the pathogenesis of GERD and the occurrence of acid pocket.
ABSTRACT
Objective To investigate the function of acid pocket in reflux esophagitis. Methods The 15 healthy controls and 24 reflux esophagitis patients were identified by reflux disease questionnaire (RDQ) and gastric endoscopy. The location of subjects' lower esophageal sphincter (LES) was determined by 4 channel esophageal manometry system. Then a single-channel pH electrode was positioned 1 cm below the distal border of the LES to monitor fasting pH for half an hour. After a standard meal, the pH was continuously measured for two hours. Then the electrode was moved to 5 cm above the proximal border of the LES to monitor the dynamic pH for 24 h.Results Acid pocket was found in 16 cases of reflux esophagitis patients(66.67%) and 10 cases of healthy individuals (10/15). Acid pocket occurred earlier in reflux esophagitis group than healthy controls [11.00(4.25-17.00) min vs 30.00(15.50-54.25) min, P＜0.05], and the average pH value was lower [1.84(1.59-2. 19) vs 2.32 (1.96-2.71), P＜0.05]. There was no statistic difference in mean pH value of gastroesophageal junction and the duration of acid pocket before the meal.Conclusion There is abnormal acid reflux in reflux esophagitis patients, and acid pocket with earlier occurrence and lower pH value may relevant to esophageal mucosal impairment.