Kaibysheva V., Trukhmanov A., Ivashkin V. Impedance-pH reflux patterns in patients with non-erosive reflux disease / 22-nd United European Gastroenterology Week October 18 - 22, 2014. Vienna, Austria.

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Авторы: Кайбышева В.О. / Трухманов А.С. / Ивашкин В.Т.


UEG week 2014

Impedance-pH reflux patterns in patients with non-erosive reflux disease

Valeria Kaibysheva*, Alexander Trukhmanov, Vladimir Ivashkin

First Moscow state medical university, Moscow, Russian Federation

Aims: To assess acid and non-acid reflux patterns in patients with non-erosive reflux disease (NERD) and erosive reflux disease (ERD) using combined esophageal pH-impedance monitoring.

Metods: 90 patients with NERD (67,6%) and 43 patients with ERD (32,3%) were underwent ambulatory 24-h esophageal pH-impedance monitoring.

24-h esophageal pH-impedance monitoring


Results: esophageal mucosa's exposure to reflux volume during 24 hour period was similar in both ERD and NERD patients (3.8% vs. 3.1%, p>0.05). Reflux-related acid exposure (pH drops (pH<4) associated with reflux detected by impedance) and reflux-related alkaline exposure (pH elevation (pH>7) associated with reflux detected by impedance) in ERD patients was higher than in NERD patients (p<0.05).

Fig. I. 24-h total bolus exposure in ERD and NERD patients

Fig. I. 24-h total bolus exposure in ERD and NERD patients


Fig. II. Combined impedance-pH recordings allows to identify the three types of reflux: a) Liquid acid reflux: retrograde drop in impedance starting distally together with a pH fall below 4

Fig. II. Combined impedance-pH recordings allows to identify the three types of reflux:b) Liquid weakly acidic reflux: retrograde drop in impedance starting distally together with a pH fall below 7 but above 4

Fig. II. Combined impedance-pH recordings allows to identify the three types of reflux: c) Liquid alkaline reflux: retrograde drop in impedance starting distally with pH values above 7

Fig. II. Combined impedance-pH recordings allows to identify the three types of reflux:   

a) Liquid acid reflux: retrograde drop in impedance starting distally together with a pH fall below 4 
b) Liquid weakly acidic reflux: retrograde drop in impedance starting distally together with a pH fall below 7 but above 4 
c) Liquid alkaline reflux: retrograde drop in impedance starting distally with pH values above 7

Table I. Reflux-related acid, alkaline and weakly - acid exposure in ERD and NERD patients


NERD Median (25th,75th)

ERD Median (25th,75th)

P

Reflux-related acid exposure, per cent time (%)

1.08% (0.5; 1.9)

2.2% (1.6; 2.9)

<0.05

Reflux-related alkaline exposure, per cent time (%)

0.13% (0; 0.49)

1.3% (0.8; 1.7)

<0.05

Reflux-related weakly - acid exposure, per cent time (%)

1.08% (0.46; 1.86)

0.04% (0; 0.2)

<0.05

Median acid (chemical) clearance time was twice longer in ERD patients (120 (76; 166) s.) in comparison to NERD's (60 (49; I 16) s.) group. There was no significant difference in median volume clearance time between ERD and NERD patients (23.3 (20.3; 27.6) vs. 19.1 (16.2; 23.6) s, p>0.05).


Fig. III. Chemical (red line) and volume (blue line) clearance time in ERD (left picture) and NERD (right picture) patients Fig. III. Chemical (red line) and volume (blue line) clearance time in ERD (left picture) and NERD (right picture) patients


Fig. III. Chemical (red line) and volume (blue line) clearance time in ERD (left picture) and NERD (right picture) patients

Conclusion: Total esophageal bolus exposure is similar in non- erosive reflux disease and erosive reflux disease, but the reflux pattern in ERD and NERD patients is different. Patients with erosive reflux disease have an increased level of reflux-related esophageal acid and alkaline exposure and long duration of chemical clearance. Patients with non-erosive reflux disease have increased level of reflux-related esophageal weakly-acid exposure and nearly normal duration of chemical and volume clearance. This observation tends to support a notion that weakly-acid reflux (4<pH<7) is less damaging to esophageal mucosa than acid (pH<4) and alkaline (pH>7) reflux.


1. Zerbib F, des Varannes SB, et al. Normal values and day-to-day variability of 24-h ambulatorreflux-related weakly - acid exposurey oesophageal impedance-pH monitoring in a Belgian-French cohort of healthy subjects. Aliment Pharmacol Ther 2005; 22:101 1-1032.

* Copyright © 2014 Kaibysheva V.O. valeriakai@mail.ru



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