Characteristics of reflux episodes and symptom association in patients with erosive esophagitis and nonerosive reflux disease: Study using combined impedance-pH off therapy

Edoardo Savarino, Radu Tutuian, Patrizia Zentilin, Pietro Dulbecco, Daniel Pohl, Elisa Marabotto, Andrea Parodi, Giorgio Sammito, Lorenzo Gemignani, Giorgia Bodini, Vincenzo Savarino

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133 Citations (Scopus)

Abstract

OBJECTIVES: We sought to compare reflux and symptom association patterns in patients with nonerosive reflux disease (NERD), erosive esophagitis (EE), and in healthy volunteers (HVs).METHODS: Patients with EE and NERD underwent combined impedance-pH monitoring. Normal values were defined on the basis of previously collected data from 48 HVs. We evaluated distal esophageal acid exposure time (AET), number and type of reflux episodes (acid, nonacid), acid and bolus clearance times, proximal extension of reflux episodes, and symptom association probability (SAP).RESULTS: Distal AET (percentage time, pH4) was higher (P0.01) in 58 EE patients (median 7.4%, 25-75th percentile 4.2-9.9%) compared with 168 NERD patients (4.2% (1.2-6.4%)) and 48 HVs (0.7% (0.2-1.4%)). Patients with EE and NERD had a higher (P0.01) number of acid reflux episodes compared with HVs (51 (37-66) vs. 34 (22-51) vs. 17 (8-31); P0.05), but a similar number of nonacid reflux episodes (22 (15-39) vs. 23 (15-38) vs. 18 (14-26); PNS). The percentage of reflux episodes reaching the proximal esophagus was higher (P0.01) in EE patients (57% (45-73%)) than in NERD patients (45% (36-60%)) and HVs (33% (19-46%)). A positive SAP for heartburn or regurgitation was found in 161 of 168 (96%) NERD and 54 of 58 (93%) EE patients (PNS).CONCLUSIONS: Acid reflux episodes, volume, and acid clearance are important factors in the pathogenesis of reflux-induced lesions. Nonacid reflux contributes less to esophageal mucosa damage, but is involved in the development of reflux symptoms in both NERD and EE patients.

Original languageEnglish
Pages (from-to)1053-1061
Number of pages9
JournalAmerican Journal of Gastroenterology
Volume105
Issue number5
DOIs
Publication statusPublished - May 2010

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Peptic Esophagitis
Electric Impedance
Esophagitis
Acids
Healthy Volunteers
Therapeutics
Heartburn
Esophagus
Reference Values

ASJC Scopus subject areas

  • Gastroenterology

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Characteristics of reflux episodes and symptom association in patients with erosive esophagitis and nonerosive reflux disease : Study using combined impedance-pH off therapy. / Savarino, Edoardo; Tutuian, Radu; Zentilin, Patrizia; Dulbecco, Pietro; Pohl, Daniel; Marabotto, Elisa; Parodi, Andrea; Sammito, Giorgio; Gemignani, Lorenzo; Bodini, Giorgia; Savarino, Vincenzo.

In: American Journal of Gastroenterology, Vol. 105, No. 5, 05.2010, p. 1053-1061.

Research output: Contribution to journalArticle

Savarino, E, Tutuian, R, Zentilin, P, Dulbecco, P, Pohl, D, Marabotto, E, Parodi, A, Sammito, G, Gemignani, L, Bodini, G & Savarino, V 2010, 'Characteristics of reflux episodes and symptom association in patients with erosive esophagitis and nonerosive reflux disease: Study using combined impedance-pH off therapy', American Journal of Gastroenterology, vol. 105, no. 5, pp. 1053-1061. https://doi.org/10.1038/ajg.2009.670
Savarino, Edoardo ; Tutuian, Radu ; Zentilin, Patrizia ; Dulbecco, Pietro ; Pohl, Daniel ; Marabotto, Elisa ; Parodi, Andrea ; Sammito, Giorgio ; Gemignani, Lorenzo ; Bodini, Giorgia ; Savarino, Vincenzo. / Characteristics of reflux episodes and symptom association in patients with erosive esophagitis and nonerosive reflux disease : Study using combined impedance-pH off therapy. In: American Journal of Gastroenterology. 2010 ; Vol. 105, No. 5. pp. 1053-1061.
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abstract = "OBJECTIVES: We sought to compare reflux and symptom association patterns in patients with nonerosive reflux disease (NERD), erosive esophagitis (EE), and in healthy volunteers (HVs).METHODS: Patients with EE and NERD underwent combined impedance-pH monitoring. Normal values were defined on the basis of previously collected data from 48 HVs. We evaluated distal esophageal acid exposure time (AET), number and type of reflux episodes (acid, nonacid), acid and bolus clearance times, proximal extension of reflux episodes, and symptom association probability (SAP).RESULTS: Distal AET (percentage time, pH4) was higher (P0.01) in 58 EE patients (median 7.4{\%}, 25-75th percentile 4.2-9.9{\%}) compared with 168 NERD patients (4.2{\%} (1.2-6.4{\%})) and 48 HVs (0.7{\%} (0.2-1.4{\%})). Patients with EE and NERD had a higher (P0.01) number of acid reflux episodes compared with HVs (51 (37-66) vs. 34 (22-51) vs. 17 (8-31); P0.05), but a similar number of nonacid reflux episodes (22 (15-39) vs. 23 (15-38) vs. 18 (14-26); PNS). The percentage of reflux episodes reaching the proximal esophagus was higher (P0.01) in EE patients (57{\%} (45-73{\%})) than in NERD patients (45{\%} (36-60{\%})) and HVs (33{\%} (19-46{\%})). A positive SAP for heartburn or regurgitation was found in 161 of 168 (96{\%}) NERD and 54 of 58 (93{\%}) EE patients (PNS).CONCLUSIONS: Acid reflux episodes, volume, and acid clearance are important factors in the pathogenesis of reflux-induced lesions. Nonacid reflux contributes less to esophageal mucosa damage, but is involved in the development of reflux symptoms in both NERD and EE patients.",
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T1 - Characteristics of reflux episodes and symptom association in patients with erosive esophagitis and nonerosive reflux disease

T2 - Study using combined impedance-pH off therapy

AU - Savarino, Edoardo

AU - Tutuian, Radu

AU - Zentilin, Patrizia

AU - Dulbecco, Pietro

AU - Pohl, Daniel

AU - Marabotto, Elisa

AU - Parodi, Andrea

AU - Sammito, Giorgio

AU - Gemignani, Lorenzo

AU - Bodini, Giorgia

AU - Savarino, Vincenzo

PY - 2010/5

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N2 - OBJECTIVES: We sought to compare reflux and symptom association patterns in patients with nonerosive reflux disease (NERD), erosive esophagitis (EE), and in healthy volunteers (HVs).METHODS: Patients with EE and NERD underwent combined impedance-pH monitoring. Normal values were defined on the basis of previously collected data from 48 HVs. We evaluated distal esophageal acid exposure time (AET), number and type of reflux episodes (acid, nonacid), acid and bolus clearance times, proximal extension of reflux episodes, and symptom association probability (SAP).RESULTS: Distal AET (percentage time, pH4) was higher (P0.01) in 58 EE patients (median 7.4%, 25-75th percentile 4.2-9.9%) compared with 168 NERD patients (4.2% (1.2-6.4%)) and 48 HVs (0.7% (0.2-1.4%)). Patients with EE and NERD had a higher (P0.01) number of acid reflux episodes compared with HVs (51 (37-66) vs. 34 (22-51) vs. 17 (8-31); P0.05), but a similar number of nonacid reflux episodes (22 (15-39) vs. 23 (15-38) vs. 18 (14-26); PNS). The percentage of reflux episodes reaching the proximal esophagus was higher (P0.01) in EE patients (57% (45-73%)) than in NERD patients (45% (36-60%)) and HVs (33% (19-46%)). A positive SAP for heartburn or regurgitation was found in 161 of 168 (96%) NERD and 54 of 58 (93%) EE patients (PNS).CONCLUSIONS: Acid reflux episodes, volume, and acid clearance are important factors in the pathogenesis of reflux-induced lesions. Nonacid reflux contributes less to esophageal mucosa damage, but is involved in the development of reflux symptoms in both NERD and EE patients.

AB - OBJECTIVES: We sought to compare reflux and symptom association patterns in patients with nonerosive reflux disease (NERD), erosive esophagitis (EE), and in healthy volunteers (HVs).METHODS: Patients with EE and NERD underwent combined impedance-pH monitoring. Normal values were defined on the basis of previously collected data from 48 HVs. We evaluated distal esophageal acid exposure time (AET), number and type of reflux episodes (acid, nonacid), acid and bolus clearance times, proximal extension of reflux episodes, and symptom association probability (SAP).RESULTS: Distal AET (percentage time, pH4) was higher (P0.01) in 58 EE patients (median 7.4%, 25-75th percentile 4.2-9.9%) compared with 168 NERD patients (4.2% (1.2-6.4%)) and 48 HVs (0.7% (0.2-1.4%)). Patients with EE and NERD had a higher (P0.01) number of acid reflux episodes compared with HVs (51 (37-66) vs. 34 (22-51) vs. 17 (8-31); P0.05), but a similar number of nonacid reflux episodes (22 (15-39) vs. 23 (15-38) vs. 18 (14-26); PNS). The percentage of reflux episodes reaching the proximal esophagus was higher (P0.01) in EE patients (57% (45-73%)) than in NERD patients (45% (36-60%)) and HVs (33% (19-46%)). A positive SAP for heartburn or regurgitation was found in 161 of 168 (96%) NERD and 54 of 58 (93%) EE patients (PNS).CONCLUSIONS: Acid reflux episodes, volume, and acid clearance are important factors in the pathogenesis of reflux-induced lesions. Nonacid reflux contributes less to esophageal mucosa damage, but is involved in the development of reflux symptoms in both NERD and EE patients.

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