The extent of oesophageal acid exposure overlap among the different gastro‐oesophageal reflux disease groups

Shapiro, Michael; Green, C.; Faybush, Elisa M.; Esquivel, Romeo F.; Fass, Ronnie

doi:10.1111/j.1365-2036.2006.02747.x

Cited by 44 publications

(26 citation statements)

References 32 publications

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“…This is supported by the findings that increased BMI is also associated with increase in the prevalence of erosive esophagitis and Barrett's esophagus, disorders that are associated with overall increase in mean esophageal acid exposure during 24-h evaluation [20].…”

Section: Esophageal Acid Exposurementioning

confidence: 53%

The Pathophysiological Mechanisms of GERD in the Obese Patient

Fass

2008

Dig Dis Sci

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Obesity has increased dramatically in the last 30 years, affecting 33% of the adult population in the United States. Increase in body mass index has been shown to be associated with the increase in the prevalence of gastroesophageal reflux disease (GERD) symptoms, esophageal mucosal injury, and GERD complications. The putative mechanisms responsible for the close relationship between GERD and increased body mass index include increased intragastric pressure, increased gastroesophageal pressure gradient, esophageal motor and sensory abnormalities, increase in prevalence of hiatal hernia, increase in serum female hormonal levels, diet, and increase in comorbidities. Whilst the current efforts are to focus on one major underlying mechanism, it is highly likely that multiple factors contribute to the increased prevalence of GERD in the obese patient.

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Section: Esophageal Acid Exposurementioning

confidence: 53%

The Pathophysiological Mechanisms of GERD in the Obese Patient

Fass

2008

Dig Dis Sci

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“…On the other hand, a study conducted by Martinez (on 36 ERD patients and 71 NERD patients, the latter including cases both positive and negative on pH monitoring) reported NERD having a lower acid exposure, but with the 39 NERD-patients we disregarded, the 32 NERD+ patients no longer differed from those with ERD [24] . Unlike the situation seen in our study, excluding patients with functional heartburn seems to make the NERD+ and ERD cases overlap in terms of severity of acid reflux [15,25,26] . In NERD patients, therefore, the progression towards esophagitis might correlate more with the duration of their disease than with any greater quantity of acid reflux [27] .…”

Section: Physiopathological Patternmentioning

confidence: 48%

Non-erosive and uncomplicated erosive reflux diseases: Difference in physiopathological and symptom pattern

Bresàdola¹

2011

WJGP

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AIM: To investigate differences in the physiopathological findings (manometry and pH monitoring) and symptoms between cases of non-erosive reflux disease (NERD) and erosive reflux disease (ERD) found positive at 24 h pH monitoring. METHODS:For a total of 670 patients who underwent 24 h pH monitoring, esophageal manometry and upper endoscopy were retrospectively evaluated, assessing the reflux symptoms, manometric characteristics of the lower esophageal sphincter (LES) and esophageal body and the presence or absence of esophagitis and hiatal hernia. Typical and atypical symptoms were also evaluated. For inclusion in the study, patients had to have NERD or ERD and be found positive on pH monitoring (NERD+). Patients with Gastroesophageal reflux disease (GERD) complicated by stenosis, ulcers or Barrett's esophagus were ruled out.RESULTS: 214 patients were involved in the study, i.e. 107 cases of NERD+ and 107 of ERD. There were no significant gender-or age-related differences between the two groups. The ERD group had more cases of hiatal hernia (P = 0.02) and more acid reflux, both in terms of number of reflux episodes (P = 0.01) and as a percentage of the total time with a pH < 4 (P = 0.00), when upright (P = 0.007) and supine (P = 0.00). The NERD+ cases had more reflux episodes while upright (P = 0.02) and the ERD cases while supine (P = 0.01). The LES pressure was higher in cases of NERD+ (P = 0.03) while the amplitude and duration of their esophageal peristaltic waves tended to be better than in the ERD group (P >0.05). The NERD+ patients presented more often with atypical symptoms (P = 0.01). CONCLUSION:The NERD+ patients' fewer reflux episodes and the fact that they occurred mainly while in the upright position (unlike the cases of ERD) may be two factors that do not favor the onset of esophagitis. The frequently atypical symptoms seen in patients with NERD+ need to be accurately evaluated for therapeutic purposes because patients with GERD and atypical symptoms generally respond only partially to medical and surgical treatments.

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“…When NERD-negative patients were excluded from the NERD group, differences in refl ux parameters between NERD and RE were no longer present, although patients with BE continued to have higher values than patients with NERD. A similar study from the same group also showed a high degree of overlap in esophageal ACT between patients with NERD and both RE and BE [ 17 ]. In the study by Martinez et al [ 16 ], the 71 patients with NERD were further divided into NERD-positive ( n = 32) or NERD-negative ( n = 39).…”

Section: Esophageal Acid Contact Timementioning

confidence: 87%

Nonerosive reflux disease: A pathophysiologic perspective

Long

Orlando²

2008

Curr Gastroenterol Rep

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Nonerosive reflux disease (NERD) is the most common phenotype of gastroesophageal reflux disease. By definition, patients with NERD have typical reflux symptoms caused by the intraesophageal reflux of gastric contents but have no visible esophageal mucosal injury. This is in contrast to patients with reflux esophagitis, also known as erosive reflux disease, and Barrett's esophagus, who have obvious esophageal mucosal injury on endoscopy. Only 50% of patients with NERD have pathologic esophageal acid contact time (ACT) as detected on 24-hour pH monitoring (ie, NERD-positive). NERD patients with physiologic esophageal ACT and good temporal correlation of symptoms with reflux events (symptom index > 50% or symptom-association probability > 95%) are considered to have esophageal hypersensitivity (ie, NERD-negative). Finally, patients with physiologic esophageal ACT but poor symptom-reflux correlation are now considered to have functional heartburn and not NERD. NERD-positive patients have motor dysfunction and acidic reflux abnormalities that are similar to patients with reflux esophagitis and Barrett's esophagus, whereas NERD-negative patients have minimal abnormalities that are not much different than healthy controls. The histopathologic feature most indicative of NERD is the presence of dilated intercellular spaces within squamous epithelium, an ultrastructural abnormality readily identified on transmission electron microscopy and on light microscopy.

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The extent of oesophageal acid exposure overlap among the different gastro‐oesophageal reflux disease groups

Abstract: SUMMARY BackgroundStudies have demonstrated that patients with Barrett's oesophagus have the highest oesophageal acid exposure profile, followed by erosive oesophagitis and non-erosive reflux disease patients, but the exact extent of overlap remains unknown.

Cited by 44 publications

References 32 publications

The Pathophysiological Mechanisms of GERD in the Obese Patient

The Pathophysiological Mechanisms of GERD in the Obese Patient

Non-erosive and uncomplicated erosive reflux diseases: Difference in physiopathological and symptom pattern

Nonerosive reflux disease: A pathophysiologic perspective

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