1998
DOI: 10.1111/j.1572-0241.1998.00402.x View full text |Buy / Rent full text
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Abstract: 1) Cardia acid exposure is present at a level intermediate between that of the esophagus and stomach; it is most commonly transient but may be continuous, similar to the stomach. 2) Refluxed esophageal acid originates from a pool of acid distal to the cardia that then bathes the cardia in sustained, repetitive, or single acid exposures and occasionally travels into the esophagus.

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“…The fraction of time of pH < 4.0 in the stomach is about 80%, 37,38 but in those studies, the pH-monitoring catheter was positioned in the gastric body, between 10 cm and 15 cm below the lower border of the LES. Katzka et al 39 studied gastric pH with the catheter positioned 5 cm below the upper border of the esophageal sphincter coincident with channel D in our study and found a variance in pH from 0.9% to 76.1% with a median of 32.2%. We considered the minimum fraction of time of 50% of pH < 4.0 as excluding proximal migration of the catheter, what happened in all cases, so no false negative results are expected in the other channels, which increases the sensibility of the method.…”
Section: Discussionsupporting
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“…The fraction of time of pH < 4.0 in the stomach is about 80%, 37,38 but in those studies, the pH-monitoring catheter was positioned in the gastric body, between 10 cm and 15 cm below the lower border of the LES. Katzka et al 39 studied gastric pH with the catheter positioned 5 cm below the upper border of the esophageal sphincter coincident with channel D in our study and found a variance in pH from 0.9% to 76.1% with a median of 32.2%. We considered the minimum fraction of time of 50% of pH < 4.0 as excluding proximal migration of the catheter, what happened in all cases, so no false negative results are expected in the other channels, which increases the sensibility of the method.…”
Section: Discussionsupporting
“…Classically, GOR has always been quantified by the measurement of acidity (oesophageal pH below 4) 5-6 cm above the upper limit of the lower oesophageal sphincter (LOS), to avoid movement of the pH electrode within the stomach. Katzka et al 1 have shown in healthy volunteers that acid oesophageal refluxes occur always in the presence of acid at the cardia level (5 cm below the proximal border of the LOS). Similarly, Fletcher et al 2 demonstrated, in GORD patients with a normal oesophageal acid exposure 5 cm above the LOS, a large increase in acid exposure just above the LOS (0.5 cm).…”
Section: Introductionmentioning
“…This was an expected finding, which is supported by several studies. [30][31][32][33][34] In addition, there is evidence to believe that the column of reflux in patients studied off acid-suppressive therapy may vary in terms of pH values, showing a decreasing gradient of pH as more distal in the esophagus, as already suggested by reports using pH alone and impedance-pH monitoring in the very distal esophagus. [36][37][38] In the present study, patients with shorter distances between PTP and pH sensor showed a higher perception of heartburn during pH monitoring, as well as higher frequency of both reflux esophagitis and sliding hiatal hernia.…”
Section: Discussionmentioning