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Review article: acidity and volume of the refluxate in the genesis of gastro‐oesophageal reflux disease symptoms
Author(s) -
SIFRIM D.,
MITTAL R.,
FASS R.,
SMOUT A.,
CASTELL D.,
TACK J.,
GREGERSEN H.
Publication year - 2007
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2007.03281.x
Subject(s) - reflux , heartburn , medicine , gastro , gastroenterology , proton pump inhibitor , pepsin , regurgitation (circulation) , disease , gastric acid , distension , esophageal disease , esophagus , stomach , biochemistry , chemistry , enzyme
Summary Background A number of mechanisms, other than acid reflux, may be responsible for the symptoms of gastro‐oesophageal reflux disease. Aim To assess the importance of non‐acid reflux mechanisms. Methods This review is based on presentations and discussion at a workshop, where specialists in the field analysed data relating to these mechanisms. Results Weakly acidic reflux, pH (4–7), detected with impedance–pHmetry is associated with regurgitation and atypical gastro‐oesophageal reflux disease symptoms. It is not clear whether pepsin and trypsin can elicit symptoms, but bile can elicit heartburn. The magnitude of reflux‐induced oesophageal distension can be determined by high frequency ultrasonography and is not reduced by proton pump inhibition, suggesting that persisting symptoms ‘on’ a proton pump inhibitor may still be due to oesophageal distension by non‐acidic reflux. Exaggerated longitudinal muscle contraction can induce non‐acid‐related heartburn. Preliminary studies showed a positive effect of baclofen, surgery or endoscopic procedures to reduce weakly acidic reflux. Conclusion Mechanisms other than acid reflux are involved in some of the symptoms of gastro‐oesophageal reflux disease. Controlled outcome studies are needed to clarify their roles and the indications for antireflux procedures in patients with persistent symptoms whilst ‘on’ a proton pump inhibitor.