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The relationship between esophageal acid exposure and the esophageal response to volumetric distention
Author(s) -
Carlson D. A.,
Kathpalia P.,
Craft J.,
Tye M.,
Lin Z.,
Kahrilas P. J.,
Pandolfino J. E.
Publication year - 2018
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.13240
Subject(s) - medicine , reflux , interquartile range , gerd , distension , eosinophilic esophagitis , gastroenterology , esophagus , cardiology , disease
Background Increased esophagogastric junction ( EGJ ) distensibility is thought to contribute to gastroesophageal reflux disease ( GERD ). Using the functional lumen imaging probe ( FLIP ), we aimed to assess the esophageal response to distension among patients undergoing esophageal pH monitoring. Methods 25 patients (ages 22‐73; 13 females) who underwent ambulatory wireless esophageal pH testing while off proton‐pump inhibitors were evaluated with FLIP during sedated upper endoscopy. Esophageal reflux was quantified by total percent acid exposure time ( AET ; <6% was considered normal). FLIP studies were analyzed using a customized program generate FLIP topography plots to identify esophageal contractility patterns and to calculate the EGJ ‐distensibility index ( DI ). Reflux symptoms were assessed with the GERDQ . Values reflect median (interquartile range). Results Among all patients, the AET was 7.2% (3.7‐11.1) and EGJ ‐ DI was 4.2 (2.5‐7.6) mm 2 /mm Hg. Repetitive antegrade contractions ( RAC s) were induced in 19/25 (76%) of patients; AET was lower among patients with (6.1%, 3‐7.8) than without (14.9, 8.5‐22.3) RAC s ( P = .009). Correlation was weak and insignificant between AET and EGJ ‐ DI , GERDQ and AET , and GERDQ and EGJ ‐ DI . Patients with abnormal AET (n = 16) and normal AET (n = 9) had similar EGJ ‐ DI , 4.6 mm 2 /mm Hg (2.9‐9.2) vs 3.2 (2.2‐5.1), P = .207 and GERDQ , P = .138. Conclusions Abnormal esophageal acid exposure was associated with an impaired contractile response to volume distention of the esophagus. This supports that acid exposure is dependent on acid clearance mechanisms.