Nguyen B.V., Topilin O.G., Ovsyannikov D.Y. Acid, non-acid reflux and clinical manifestations of GERD. A meta-analysis / SCIENCE4HEALTH 2019. Клинические и теоретические аспекты современной медицины. Материалы Х Международной научной конф. М.:РУДН, 2019.

Авторы: Нгуен Б.В. / Топилин О.Г. / Овсянников Д.Ю.

Acid, non-acid reflux and clinical manifestations of GERD. A meta-analysis

Nguyen Bich Van, Topilin Oleg Grigorievich, Dmitry Y. Ovsyannikov

Scientific supervisor: Dmitry Y. Ovsyannikov, MD

The Medical Institute, Department of Pediatrics, RUDN University, Moscow, Russia


Background: It is currently known that atypical manifestations, such as respiratory (recurrent pneumonia, obstructive bronchitis, asthma, chronic cough ...), cardiovascular, dental, otorhinolaryngeal diseases may be the single clinical symptoms of gastroesophageal reflux disease (GERD), which respond poorly to appropriate treatment and often recur. Typical manifestations of GERD - heartburn, regurgitation - are usually caused by acid reflux (AR). A non-acidic reflux (NAR), detected only by combined multichannel intraluminal impedance-pH (MII-pH), is now becoming focus of GERD. The sensitivity of esophageal pH monitoring in determining the NAR is very low - about 28%. 83% of the NAR detected by 24 hours pH-metry are denied according to the impedance data. Therefore, only studies these use MII-pH are selected to this review.

Purpose is to assess the relationship between types of reflux (acid, non-acid) and clinical manifestations (typical, atypical) of GERD.

Methods and materials: a literature search was undertaken using PubMed for the keyword “GER” [MeSH] and “esophageal pH monitoring” [MeSH] and Russian sources (elibrary.ru,Cyberleninka.ru) until 09-01-2019. Clinical study, comparative study, controlled study, observational study, placebo-controlled trials - using 24 hours MII-pH to diagnose GERD and assess the relationship between clinical symptoms and reflux types (acid, non-acid) based on symptom association probability (SAP) were selected. Patients with clinical manifestations (typical or atypical) suspected of GERD, without age limit, who underwent 24 hours MII-pH, not using inhibitors proton pump (IPP) for at least 3 days, other medicines (antacid, prokinetics ...) 1 day prior to the study. Patients have not neurological diseases.

Results and discussion: 1447 articles were found, in which 95 articles were fully analyzed. 17 articles met inclusion criteria: 11 with typical and 10 with atypical manifestations of GERD. Typical symptoms are usually caused by acid reflux with RR acid / non-acid reflux = 3.09 (2.32, 4.13). And atypical symptoms (mainly respiratory symptoms, such as chronic cough, asthma, apnea), are most often caused by non-acidic reflux with RR acid / non-acid reflux = 0.57 (0.37, 0.88). This result is consistent and explains the effectiveness of anti-reflux therapy. IPP is effective in treating the typical symptoms of GERD, it is not homogeneous with atypical clinic, but surgical interventions - fundoplication gives a good result with both typical and atypical manifestations of GERD. Indeed, if the typical symptoms of GERD are caused by AR, under the influence of drugs that reduce gastric acidity (IPP), the clinic improves. Atypical symptoms are largely due to NAR - or high acidity of the reflux does not play an important role in the occurrence of clinical manifestations - it is obvious that IPP reduces the acidity of the reflux content, but does not break the pathogenetic chain. The total number of refluxes did not decrease during the treatment by IPP, the number of AR just turns into NAR. Meanwhile, surgery - the restoration of the lower esophageal sphincter, which prevented the flow of reflux - thus, AR and NAR are solved.

Conclusion: in patients with typical manifestations of GERD, there is a high probability of AR. And on the contrary, NAR is more characteristic of atypical manifestations of GERD, including respiratory manifestations.

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