Systematic review: role of acid, weakly acidic and weakly alkaline reflux in gastro‐oesophageal reflux disease

Abstract

Aliment Pharmacol Ther 2010; 32: 334–343SummaryBackground The importance of weakly acidic and weakly alkaline reflux in gastro‐oesophageal reflux disease (GERD) is gaining recognition.Aim To quantify the proportions of reflux episodes that are acidic (pH <4), weakly acidic (pH 4–7) and weakly alkaline (pH >7) in adult patients with GERD, and to evaluate their correlation with symptoms.Methods Studies were identified by systematic PubMed and Embase searches. Data are presented as sample‐size weighted means and 95% confidence intervals.Results In patients with GERD taking a proton pump inhibitor (PPI), 80% (76–84%) of reflux episodes were weakly acidic or weakly alkaline and 83% (78–88%) of reflux symptom episodes were associated with weakly acidic or weakly alkaline reflux episodes. In patients with GERD not taking a PPI, 63% (59–67%) of reflux episodes were acidic and 72% (57–87%) of reflux symptom episodes were associated with acid reflux episodes. Six studies presented data separately for weakly alkaline reflux, which accounted for <5% of all reflux episodes, both on and off PPI therapy.Conclusions Weakly acidic reflux underlies the majority of reflux episodes in patients with GERD on PPI therapy, and is the main cause of reflux symptoms occurring despite PPI therapy.

Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease

“…As demonstrated by these studies, impedance-pH testing covers all possible scenarios for persistent symptoms in a treated patient: ongoing acid refl ux, ongoing non-acid refl ux, or no refl ux. Furthermore, a systematic review that quantifi ed acid and nonacid (both weakly acidic and weakly alkaline) refl ux in studies of GERD patients taking a PPI, found that weakly acidic refl ux underlies the majority of refl ux episodes in these patients and is the main cause of persistent symptoms despite PPI therapy ( 157 ). Finally, a negative impedor repeat work-up for non-GERD (pulmonary, allergic, ENT) etiologies.…”

Deoxycholic acid causes DNA damage while inducing apoptotic resistance through NF-κB activation in benign Barrett's epithelial cells

“…Media were added for 5, 10, or 30 min to equally seeded wells of subconfluent cells and then removed, and the samples were collected for analyses (see below). Exposure durations, bile acid concentrations, and pH were chosen to simulate typical episodes of gastroesophageal reflux in GERD patients who take PPIs (4,7,23,27).…”

Gastric myoelectrical activity in children and youth with gastroesophageal reflux disease

“…w systematycznym przeglądzie piśmiennictwa podkreślili rolę refluksu słabo kwaśnego (pH = 4-7) i słabo zasadowego (pH > 7) w GERD [16]. Badacze wykazali, że w grupie pacjentów z tym schorzeniem nieprzyjmujących inhibitorów pompy protonowej (IPP) incydenty słabo kwaśne i słabo zasadowe stanowiły 37% (33-41%) ogółu epizodów GERD i odpowiadały one za 28% (13-43%) objawów klinicznych.…”