Duodeno-Gastric Reflux and Acid Secretion in Patients with Symptomatic Hiatal Hernia

Stol, D. W.; Murphy, G. M.; Collis, J. Leigh

doi:10.1080/00365521.1974.12096797

Cited by 52 publications

(2 citation statements)

References 11 publications

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“…Determination of bile salts in reflux matter has been suggested. Duodenogastric reflux is observed more in patients with reflux esophagitis (13). Bile salts are proposed as a cause of esophagitis, since many unconjugated bile salts are insoluble at an acid pH (14).…”

Section: Discussionmentioning

confidence: 99%

Alkaline Gastroesophageal Reflux in Infancy

Vandenplas,

Loeb

1991

J. pediatr. gastroenterol. nutr.

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SummaryAlkaline gastroesophageal reflux is a rare disorder, although it has been suggested as a cause of esoph‐agitis. However, up to now, there exists no unequivocally accepted diagnostic method for alkaline reflux that can be routinely applied. “Normal ranges” of episodes of pH greater than 7.0–7.5 in asymptomatic as well as in symptomatic infants are proposed. In the asymptomatic infants (n = 83), the mean percentage of time the pH was > 7.0 was 1.3 ± 2.6, and the number of episodes in 24 h with a pH > 7.0 was 10.4 ± 16.4. In the symptomatic group (n = 60), including infants with chronic vomiting, the mean percentage of time the pH was greater than 7.0 was 0.15 ± 0.5, and the number of episodes with a pH greater than 7.0 was 2.8 ± 5.5. In all but six infants the percentage of time the pH was greater than 7.5 was less than 0.1. In three of four of these infants (endoscopy was refused by two parents) whose conditions exceeded the cut‐off limits, there was a histologically proven esophagitis. To evaluate the proposed “normal” ranges for episodes of pH greater than 7.0 and 7.5, 200 symptomatic children were included in a prospective study. Symptoms were repetitive vomiting (n = 110), excessive crying (n = 53), and chronic respiratory disease (n = 37). Esophagoscopy was performed in 18 babies (9%) because pH monitoring data exceeded the proposed limits for the percentage of time the pH was greater than 7.0. The percentage of time the pH was greater than 7.5 was increased in 13 (6.5%) infants. Esophagitis was proven by histologic study in nine infants (4.5% of the total group): in three of nine, reflux was “mixed” (acid and alkaline); in six of nine, reflux was alkaline. If data exceed the proposed limits of episodes with a pH greater than 7.5, alkaline reflux is likely to occur and should be further investigated (e.g., by double esophageal or combined gastric and esophageal pH monitoring) to confirm the diagnosis of alkaline reflux.

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Section: Discussionmentioning

confidence: 99%

Alkaline Gastroesophageal Reflux in Infancy

Vandenplas,

Loeb

1991

J. pediatr. gastroenterol. nutr.

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“…thi s The few infants with esophagitis de spite normal pH monitoring data po ssibly suffe red from combined acid and bile reflu x. It was demonstrated that duodenogastric reflux is more common in patients with esophagitis (14). Many unconjugated bile salts are insoluble at an acid pH; bile salts can damage the esophageal mucosa and cause esophagitis (15).…”

Section: Discussionmentioning

confidence: 99%

Area Under pH 4

Vandenplas,

Franckx‐Goossens,

Pipeleers‐Marichal

et al. 1989

J. pediatr. gastroenterol. nutr.

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Summary:Twenty‐four‐hour continuous esophageal pH monitoring has become the preferred test to quantify acid gastroesophageal reflux. Agreement has been achieved that acid gastric content reflux into the esophagus constitutes a major cause of reflux esophagitis; we therefore calculated the “area under pH 4” (A) in 560 consecutive pH monitorings in infants 1‐12 months old and related this parameter (A) to the reflux index (RI): RI < 10%: A 185 ± 295 (mean ± 1 SD); RI 10‐19%: A 1,046 ± 1,206; RI 20‐29%: A 1,967 ± 2,038; RI 30‐39%: A 3,307 ± 2,955; RI > 40%: A 7,977 ± 7,227. A higher RI is associated with a greater area under pH 4 (p < 0.001); the high SD obtained in each group, however, illustrates the great variability in surface (or acidity of the reflux episodes) in all groups. Esophagoscopy and biopsy were performed in 112 infants (20%). Specificity in the prediction of (mild) esophagitis was higher for the area under pH 4 (88%) compared with the RI (50%). The sensitivity of both parameters was comparable (96 versus 93%). Our results strongly suggest that in young infants, the acidity of the reflux episodes (the area under pH 4) is a determining factor in the prediction of esophagitis. These data need to be confirmed by more studies before general application of this parameter can be advised.

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The pattern of bile salt reflux and acid secretion in sliding hiatal hernia

Crumplin

Stol

Murphy

et al. 1974

Journal of British Surgery

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The role played by gastric fluid refluxed from the stomach into the oesophagus of patients with symutomatic sliding hiatal hernia has been evaluated in terms of gastric bile salt concentration and acid secretion rates. Patients with a peptic stricture had a higher basal acid output than control subjects. Approximately half of both hiatal hernia groups studied had periods of increased total bile salt concentrations either while fasting or following a test meal, This would indicate abnormal pyloric function in these patients. The quantitative examination of total and individual bile salts in solution in gastric juice suggests that a combination of gastric acid pepsin and bile may be a major, factor in the pathogenesis of the clinical responses to gastrooesophageal reflux. Neither total nor individual bile salt concentrations found in gastric juice helped to differentiate between the specific types of response seen in symptomatic sliding hiatal hernia.

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Duodeno-Gastric Reflux and Acid Secretion in Patients with Symptomatic Hiatal Hernia

Cited by 52 publications

References 11 publications

Alkaline Gastroesophageal Reflux in Infancy

Alkaline Gastroesophageal Reflux in Infancy

Area Under pH 4

The pattern of bile salt reflux and acid secretion in sliding hiatal hernia

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