Juice Test for Identification of Nonerosive Reflux Disease in Heartburn Patients

Abstract

Background/AimsEvaluation of esophageal clearance by orange juice swallowing could be useful to identify different categories of gastroesophageal reflux disease. We determined whether a juice test at the beginning of esophageal pH monitoring can identify nonerosive reflux disease (NERD) among heartburn patients.MethodsMultiple swallows of orange juice (pH 3) were performed at the beginning of esophageal pH monitoring in 71 heartburn patients off acid-suppressive therapy. The area between pH drop below 5 and recovery to 5 was calculated from pH tracings and named Delta5 (mmol·L−1·sec). Fifteen healthy subjects served to determine Delta5 cutoff (95th percentile). Patients were classified as NERD, non-NERD (a mix of reflux hypersensitivity, functional heartburn, and undetermined), and erosive disease depending on acid exposure, reflux symptom analysis, and upper endoscopy.ResultsDelta5 cutoff in healthy subjects was 251 mmol·L−1·sec. Among 71 patients, 23 had NERD, 26 had non-NERD, and 22 had erosive disease. Compared to non-NERD, Delta5 was higher in both NERD (median [interquartile range]: 316 [213–472] vs 165 [105–225]; P < 0.01) and erosive disease (310 [169–625] vs 165 [105–225]; P < 0.01). An elevated Delta5 (> 251 mmol·L−1·sec) showed sensitivity of 74% and specificity of 81% for identification of NERD. Positive and negative likelihood ratios were 3.84 and 0.32 respectively, whereas test accuracy was 78%.ConclusionsA juice test with calculation of Delta5 helps in the identification of true NERD among heartburn patients with endoscopy-negative reflux disease. In these patients, an elevated Delta5 could make prolonged reflux testing unnecessary.

Clinical and Functional Features of Gastroesophageal Reiflux Disease, Comorbid With Peptic Ulcer Disease

“…Более того, выявлена прямая корреляция возраста и стадии ГЭРБ с положительным КПТ, отражающим нарушение проницаемости СО пищевода, во многом из-за которых больные с ГЭРБ и НЭРБ более восприимчивы к раздражающим пищеводным стимулам, чем здоровые люди [17]. Полученные результаты находят отражение в работах с орошением пищевода пищевыми кислотными напитками для уточнения диагноза НЭРБ у больных с изжогой [18]. Обоснованность применения таких методик объясняется повышенной кислотной проницаемостью и раздражением нервных окончаний при наличии НЭРБ и даже у здоровых добровольцев [19,20,21].…”