Patterns of acid reflux in complicated oesophagitis.

Robertson, Douglas R.; Aldersley, M.; Shepherd, H. A.; Smith, Carl C.

doi:10.1136/gut.28.11.1484

Cited by 115 publications

(71 citation statements)

References 8 publications

(1 reference statement)

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“…3,[8][9][10][11][12][13][14][15][16][17] Acid reflux episodes lasting for more than 5 min have been related to defective oesophageal acid clearance, 8 which in turn correlates with the severity of mucosal lesions. 31 Hence, many studies have focused on this pH-metric parameter.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 This explanation is based on the common belief that nocturnal oesophageal acid reflux is critically involved in the development of mucosal lesions in GERD: 7 acid reflux occurring at night in the recumbent position has the highest probability of damaging the oesophageal mucosa owing to the loss of drainage by gravity and to the absence of primary peristalsis and salivation during sleep. However, although some pH-metric studies support a critical role for nocturnal oesophageal acid exposure in the development of mucosal lesions in GERD, [8][9][10][11][12][13] others do not. 3,[14][15][16][17] Unfortunately, in these studies, the series were relatively small, the definitions of supine and nocturnal acid reflux were not clearly stated and complicated reflux disease was poorly represented.…”

Section: Introductionmentioning

confidence: 99%

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Different patterns of oesophageal acid exposure distinguish complicated reflux disease from either erosive reflux oesophagitis or non‐erosive reflux disease

Frazzoni

Micheli

Savarino

2003

Aliment Pharmacol Ther

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SummaryBackground : The reason why less than one‐half of patients with gastro‐oesophageal reflux disease develop complicated reflux disease (ulcerative oesophagitis, oesophageal strictures and Barrett's oesophagus) and erosive reflux oesophagitis is not fully understood. Supine nocturnal oesophageal acid reflux is considered to be critically involved in this phenomenon, but reliable data are lacking.Aim : To clarify whether high levels of supine nocturnal oesophageal acid exposure are associated with complicated reflux disease.Methods : Ambulatory 24‐h oesophageal pH monitoring was performed in 220 patients with gastro‐oesophageal reflux disease (56 with complicated reflux disease, 76 with erosive reflux oesophagitis and 88 with non‐erosive reflux disease). The total, supine nocturnal and upright diurnal percentage acid reflux times were calculated.Results : The total percentage acid reflux time was significantly greater in complicated reflux disease than in either erosive reflux oesophagitis (P = 0.024) or non‐erosive reflux disease (P = 0.000). These differences were entirely due to a greater supine nocturnal percentage acid reflux time (P = 0.038 and P = 0.000, respectively), whereas no difference was observed in the upright diurnal percentage acid reflux time.Conclusions : Complicated reflux disease is characterized by high levels of supine nocturnal percentage acid reflux time. Prospective studies would be appropriate to clarify whether the normalization of this parameter is relevant to the effective management of this subset of patients with gastro‐oesophageal reflux disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Different patterns of oesophageal acid exposure distinguish complicated reflux disease from either erosive reflux oesophagitis or non‐erosive reflux disease

Frazzoni

Micheli

Savarino

2003

Aliment Pharmacol Ther

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“…In the absence of acid neutralization or acid suppression, the degree of esophageal damage has been found to correlate with the degree of esophageal acid exposure through gastro-esophageal reflux (GERD) with esophageal 24-hour pH monitoring in humans (22,23). However, gastric acid is not the only substance that refluxes from the stomach into the esophagus.…”

Section: Discussionmentioning

confidence: 99%

Antacid Drug Use and Risk of Esophageal and Gastric Adenocarcinomas in Los Angeles County

Duan

Sullivan‐Halley

et al. 2009

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Objectives: Concern has been expressed that antacid drugs increase the risk of esophageal and gastric adenocarcinomas.Methods: This population-based case-control study recruited patients with incident esophageal adenocarcinoma (n = 220), gastric cardiac adenocarcinoma (n = 277), or distal gastric adenocarcinoma (n = 441) diagnosed between 1992 and 1997, and 1,356 control participants in Los Angeles County. Unconditional polychotomous multivariable logistic regression analyses were done to evaluate the association between antacid drug use and these cancers. Results: Among participants who took nonprescription acid neutralizing agents for >3 years, the odds ratio for esophageal adenocarcinoma was 6.32 compared with never users (95% confidence interval, 3.14-12.69; P trend < 0.01). Analyses stratified by history of physician diagnosed upper gastrointestinal (UGI) disorders revealed a greater increase in esophageal adenocarcinoma risk associated with nonprescription antacid use among persons with no UGI disorder than among those with an UGI disorder (homogeneity of trends P = 0.07). Regular use of nonprescription acid neutralizing agents was not associated with risk of adenocarcinomas of the gastric cardia or distal stomach. Regular use of prescription acid suppressive drugs was not associated with risk for any of these cancers. Conclusion: We found risk of esophageal adenocarcinoma was greater among long-term nonprescription acid neutralizing drugs in participants without physician-diagnosed UGI conditions than among those with these conditions; this may represent self medication for undiagnosed precursor conditions or it may be that nonprescription acid neutralizing drugs, taken without limitation on amount used when symptoms are most intense, may permit alkaline bile reflux into the lower esophagus, thereby increasing esophageal adenocarcinoma risk. (Cancer Epidemiol Biomarkers Prev 2009;18(2):526 -33)

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“…1 Gastric acidity and pattern of gastro-oesophageal re¯ux may in¯uence the extent of oesophageal tissue damage. 6,7 Lower oesophageal sphincter (LES) tone has been considered an important determinant for competence of the cardia and in predicting long-term outcome. 2,8 Gastric Helicobacter pylori infection is probably not a causal factor in re¯ux oesophagitis, but is thought to affect response to acidsuppressive therapy with omeprazole.…”

Section: Introductionmentioning

confidence: 99%

Prognostic factors for relapse of reflux oesophagitis and symptoms during 12 months of therapy with lansoprazole

Hatlebakk

Berstad

1997

Aliment Pharmacol Ther

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Background:Symptom relief and endoscopic healing are both important treatment goals in patients with reflux oesophagitis. Knowledge of predictive factors for treatment success could facilitate choice of treatment in individual patients.Aim:To assess the value of clinical data and data from baseline ancillary investigations in predicting the outcome of maintenance therapy with a proton pump inhibitor.Methods:After healing and symptom relief had been obtained on open therapy with lansoprazole 30 mg daily, 103 patients with reflux oesophagitis grade 1 or 2 were randomized to maintenance therapy with lansoprazole 15 or 30 mg daily, and time until recurrence of symptoms and/or endoscopic changes was recorded. The predictive value of the following variables was assessed by Cox regression analysis: dose of lansoprazole, symptom severity, grade of reflux oesophagitis, Helicobacter pylori infection status, lower oesophageal sphincter resting tone, percentage of 24 h with an oesophageal pH of <4.0, and median 24 h intragastric pH before start of treatment.Results:Dose of lansoprazole (P = 0.01) and symptom severity (P < 0.05) both significantly predicted time to relapse. Grade of reflux oesophagitis had only a borderline predictive value (P = 0.09), while H. pylori infection status and data from manometry and intraoesophageal 24‐hour pH‐metry did not predict relapse.Conclusions:Symptom severity before starting therapy is a significant predictive factor for treatment success during potent antisecretory therapy with lansoprazole, more so than endoscopic grade of reflux oesophagitis. In a group of patients with uncomplicated reflux oesophagitis being considered for maintenance therapy with lansoprazole, ancillary investigations with endoscopy, manometry and 24‐hour pH‐metry gave very limited prognostic information. H. pylori infected patients relapsed as early as patients who were not infected.

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Patterns of acid reflux in complicated oesophagitis.

Cited by 115 publications

References 8 publications

Different patterns of oesophageal acid exposure distinguish complicated reflux disease from either erosive reflux oesophagitis or non‐erosive reflux disease

Different patterns of oesophageal acid exposure distinguish complicated reflux disease from either erosive reflux oesophagitis or non‐erosive reflux disease

Antacid Drug Use and Risk of Esophageal and Gastric Adenocarcinomas in Los Angeles County

Prognostic factors for relapse of reflux oesophagitis and symptoms during 12 months of therapy with lansoprazole

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