We confirm a significant miss rate for polyps or adenoma during colonoscopy. Detection of flat polyps is an issue that must be focused on to improve the quality of colonoscopy.

Fundoplication restores a competent barrier for all types of reflux. Reflux events are mostly non-acid after surgery, and such events may be positively correlated with symptoms.

Gastro-oesophageal reflux events should be related to gastric contents. The goal of this study was to determine the relationship between gastric pH and the nature of reflux events. Ambulatory oesophageal pH-impedance and gastric pH monitoring was performed in 41 patients [29 off and 12 on proton pump inhibitor (PPI) therapy] and 12 controls. The mean gastric pH was measured within 2 min around the reflux episodes, 10 cm below the cardia. Acid reflux events occurred more frequently at gastric pH <4 (89%) than non-acid reflux events (63%, P < 0.0001). Acid reflux events extended more frequently 15 cm above the lower oesophageal sphincter (LOS; 34%) than non-acid reflux episodes (24%, P = 0.005). Gastric pH was significantly lower during interprandial reflux events than during postprandial ones in the three groups (P < 0.001). A positive correlation was found between gastric pH and the nadir oesophageal pH during reflux events in the three groups: this correlation was more significant in patients on PPI therapy. We conclude that most acid and non-acid reflux episodes occur at acid gastric pH, as measured 10 cm below the LOS. This measure does not appear a good predictor of the pH of reflux events.

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