Time esophageal pH<4 overestimates the prevalence of pathologic esophageal reflux in subjects with gastroesophageal reflux disease treated with proton pump inhibitors
A Stanford University study reported that in asymptomatic GERD patients who were being treated with a proton pump inhibitor (PPI), 50% had pathologic esophageal acid exposure. Aim: We considered the possibility that the high prevalence of pathologic esophageal reflux might simply have resulted from calculating acidity as time pH<4.
Methods: We calculated integrated acidity and time pH<4 from the 49 recordings of 24-hour gastric and esophageal pH from the Stanford study as well as from another study of 57 GERD subjects, 26 of whom were treated for 8 days with 20 mg omeprazole or 20 mg rabeprazole in a 2-way crossover fashion.
Results: The prevalence of pathologic 24-hour esophageal reflux in both studies was significantly higher when measured as time pH<4 than when measured as integrated acidity. This difference was entirely attributable to a difference between the two measures during the nocturnal period.
Even with this difference, however, values for integrated gastric acidity and time gastric pH<4 both provided useful information regarding the odds of pathologic esophageal reflux.
Conclusions: In GERD subjects treated with a PPI, measuring time esophageal pH<4 will significantly overestimate the prevalence of pathologic esophageal acid exposure over 24 hours and during the nocturnal period.
Author: Lauren B. Gerson, George Triadafilopoulos, Peyman Sahbaie, Winston Young, Sheldon Sloan, Malcolm Robinson, Philip B. Miner, Jr. and Jerry D. Gardner
Credits/Source: BMC Gastroenterology 2008, 8:15
Published on: 2008-05-23
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