ABSTRACT
A previous study showed that supine gastroesophageal reflux occurs mainly in the early nighttime period and is greater if the patient retires within 2 hr of a meal. We analyzed 306 consecutive esophageal pH studies between January and July 2003. Ninety-two patients had abnormal supine reflux. The recumbent period was divided into quarters (Q1-Q4) and reflux parameters were calculated for each period. Reflux was maximal in Q1, and decreased progressively from Q1 to Q4 (P<0.001). Median time between evening meal and retiring was no different from that for 44 upright gastroesophageal reflux patients. Patients retiring within 2 hr of a meal had a higher percentage supine reflux time (P=0.012), but no increase in reflux was observed in those retiring within 3 hr. Supine reflux occurs maximally in the early nighttime period. Although not fully explained as a postprandial phenomenon, these patients should avoid going to bed within 3 hr of a meal.
Subject(s)
Circadian Rhythm/physiology , Gastric Acid/metabolism , Gastroesophageal Reflux/physiopathology , Supine Position/physiology , Adolescent , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Gastric Acidity Determination , Gastroesophageal Reflux/metabolism , Humans , Male , Middle Aged , Prognosis , Retrospective StudiesABSTRACT
AIM: To assess the level of undiagnosed coeliac disease (CD) in relatives of patients affected by the condition. METHODS: We collected blood from 914 relatives of probands. We screened these individuals by ELISA for IgA and IgG tTG antibodies, confirming any positive IgA tTG results with an IgA EMA and looked for evidence of IgA deficiency in those who were IgG tTG positive alone, and performed IgG1 EMA in these individuals. We undertook HLA typing where positive screening was found, and this confirmed a strong prevalence of HLA-DQ2 in the coeliac population. Follow-up small intestinal biopsy was undertaken in cases with positive serological screening, wherever possible. RESULTS: Use of this serological screening algorithm revealed a prevalence of undiagnosed CD in 5%-6% of first degree relatives of probands. CONCLUSION: Our data suggests that first degree relatives of individuals with CD should be screened for this condition.
Subject(s)
Algorithms , Celiac Disease/diagnosis , Celiac Disease/genetics , Genetic Testing/methods , Adult , Biopsy , Celiac Disease/blood , Celiac Disease/pathology , Female , HLA-DQ Antigens/blood , HLA-DQ Antigens/genetics , Humans , Immunoglobulin A/blood , Immunoglobulin G/blood , Intestine, Small/pathology , Male , Middle Aged , Pedigree , Prevalence , Transglutaminases/genetics , Transglutaminases/immunologyABSTRACT
The acid perfusion test (APT) is a test of esophageal acid sensitivity. In gastroesophageal reflux disease (GERD), the APT has largely been superseded by indexes derived from 24-hr esophageal pH monitoring: symptom index (SI), symptom sensitivity index (SSI), and symptom association probability (SAP). To evaluate the role of APT in patients with GERD we compared values of SI, SSI, and SAP in 126 APT+ and 146 APT- patients. Median values for SI, SSI, and SAP were higher in the APT+ compared with the APT- group (P < 0.001). More patients had a positive SI, SSI, and SAP in the APT+ compared with the APT- group (SI, P < 0.0001; SSI and SAP, P < 0.001). Patients with a negative APT were unlikely to have symptoms caused by acid reflux (negative predictive value, 86%). APT may be useful in detecting acid sensitivity in patients who do not report symptoms on 24-hr esophageal pH monitoring.
