No abstract available.
Esophageal pH Monitoring* ; Gastroesophageal Reflux*

BACKGROUND/AIMS: Impedance-pH monitoring allows detailed characterization of gastroesophageal reflux and esophageal activity associated with reflux. We assessed the characteristics of nocturnal reflux and esophageal activity preceding and following reflux. METHODS: Impedance-pH tracings from 11 healthy subjects and 76 patients with gastroesophageal reflux disease off acid-suppressive therapy were analyzed. Characteristics of nocturnal supine reflux, time distribution and esophageal activity seen on impedance at 2 minute intervals preceding and following reflux were described. RESULTS: Patients had more nocturnal reflux events than healthy subjects (8 [4-12] vs 2 [1-5], P = 0.002), with lower proportion of weakly acidic reflux (57% [35-78] vs 80% [60-100], P = 0.044). Nocturnal reflux was mainly liquid (80%) and reached the proximal esophagus more often in patients (6% vs 0%, P = 0.047). Acid reflux predominated in the first 2 hours (66%) and weakly acidic reflux in the last 3 hours (70%) of the night. Most nocturnal reflux was preceded by aboral flows and cleared by short lasting volume clearance. In patients, prolonged chemical clearance was associated with less esophageal activity. CONCLUSIONS: Nocturnal weakly acidic reflux is as common as acid reflux in patients with gastroesophageal reflux disease, and predominates later in the night. Impedance-pH can predict prolonged chemical clearance after nocturnal acid reflux.
Electric Impedance ; Esophageal pH Monitoring ; Esophagus ; Gastroesophageal Reflux ; Humans

BACKGROUND/AIMS: Twenty-four-hour ambulatory esophageal pH monitoring is considered the gold standard for diagnosing gastroesophageal reflux disease. The aim of this study was to quantify normal distal esophageal acid parameters in healthy Koreans. METHODS: Thirty healthy adults who were not on medication and were free from gastrointestinal symptoms were analyzed. Ambulatory esophageal acid (pH <4) exposure parameters were recorded at 5 cm above the lower esophageal sphincter. RESULTS: The 95th percentiles for reflux parameters assessed in the distal esophagus were as follows: percentage of total time with pH <4, 5.10%; percentage of upright time with pH <4, 7.88%; percentage of supine time with pH <4, 4.00%; number of reflux episodes, 62.7; number of reflux episodes with pH <4 for >5 minutes, 5.3; and the longest single acid-exposure episode, 21.3 minutes. CONCLUSIONS: Physiological gastroesophageal reflux occurs frequently in healthy Koreans. These data provide a reference range that could be utilized in studies involving Korean subjects.
Adult ; Esophageal pH Monitoring ; Esophageal Sphincter, Lower ; Esophagus ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration ; Reference Values

BACKGROUND: Failed or hypotensive peristalsis, two of the diagnostic criteria for NEMD, correlates with impaired anterograde propulsion and retrograde escape of esophageal contents. The aim of this study was to evaluate esophageal acid clearance (EAC) in patients with ineffective esophageal motility (IEM). METHODS: Of 252 patients performing esophageal manometry and ambulatory esophageal pH monitoring, 51 patients with normal motility and acid reflux and 40 patients with IEM and acid reflux were included. RESULTS: The amplitude of peristaltic waves in the proximal and distal esophagus and lower esophageal sphincter pressure was lower significantly in patients with IEM than those with normal motility. Percentage of time of pH<4 in total, upright, and supine period and number of reflux episodes was not different in both. Supine EAC was significantly increased in patients with IEM when compared to those with normal motility. Upright EAC was not different in both. CONCLUSION: We concluded supine EAC is increased in patients with IEM. Since IEM is frequently associated with gastroesophageal reflux disease (GERD), a more intensive therapy must be needed. We propose IEM can be as a specific entity of primary esophageal motility disorder, especially in patients with GERD.
Esophageal Motility Disorders ; Esophageal pH Monitoring ; Esophageal Sphincter, Lower ; Esophagus ; Gastroesophageal Reflux ; Humans ; Manometry ; Peristalsis ; United Nations

PURPOSE: The aim of this study was to evaluate the clinical significance of 24 hour pH monitoring in the pediatric patients with recurrent vomiting or regurgitation. METHODS: We performed 24 hour pH monitoring on 87 pediatric patients with recurrent vomiting or regurgitation using GastrograpH with glass electrode. The pathologic GER was determined by the reflux index (RI). RIs>10% were considered positive in patients <1 year of age, whereas RIs of <5% were positive in other age groups. We evaluated the mean and standard deviation of the reflux parameters between physiologic and pathologic GER groups, and also compared the reflux indices of each group with respect to time zones of the day. RESULTS: Pathologic GER was found in 32 of 87 patients (36.8%), and the age incidence included 32.5% in infants <6 months old, 13.3% in infants aged 6 months-1 year old, 61.5% in children aged 1~2 years old, 14.3% in children aged 2~3 years old and 66.7% in children >3 years old. In physiologic GER patients, the RI was 3.7+/-2.9% for the patients <1 year old (group A), and 1.8+/-1.5% for those > or =1 year old (group B) which was statistically significant between the 2 age groups (p=0.02). The number of long refluxes more than 5 minutes was significantly increased (p=0.03) in group A (1.7+/-1.9) than in group B (0.8+/-1.0). The duration of the longest reflux was significantly longer (p=0.007) in group A (604+/-551 sec) than in group B (275+/-296 sec). In pathologic GER patients, the RI was 17.7+/-11.6% for the patients <1 year old and 7.8+/-2.9 for those > or =1 year old. The number of long refluxes of more than 5 minutes were 8.9+/-4.6 and 3.2+/-1.8, and the duration of the longest reflux were 1955+/-2190 sec and 1093+/-706 sec for each age group. In both physiologic and pathologic GER patients, there was no significant difference of RI among the time zones of the day. CONCLUSION: Pathologic GER was found in 36.8% of patients. There was significant difference of RI between those <1 year old and those > or =1 year old in physiologic GER patients. There was no significant difference of RI among the time zones of the day in both pathologic and physiologic groups. In our study, the frequency of pathplogic GER was too much higher in age group of 1~2 years old (61.5%) than in group of 6 months-1 year old (13.3%), which means that further study is needed to determine the pathologic criteria of RI (Vandenplas criteria is >5%) in the age group of 1~2 years old.
Child* ; Electrodes ; Esophageal pH Monitoring* ; Gastroesophageal Reflux ; Glass ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Infant ; Vomiting*

OBJECTIVEAn unhealthy food consumption habit attributes to one of the etiology of gastro-esophageal reflux. The purpose of this article was to study the influence of food intake before going to bed on the nighttime gastro-esophageal reflux.

METHODSThirty-eight children with upper gastrointestinal symptoms were divided into two groups on the basis of taking (Group A, n=16) or not taking (Group B, n=22) food (non-stimulating) within 2 hrs before going to bed. All of them underwent 24 hr esophageal pH monitoring. The times of reflux episode, the longest duration of reflux, the times of reflux duration > 5 min, and the percentage of time of pH < 4 were compared between the two groups.

RESULTSThere were no significant differences in the parameters of pH monitoring between Groups A and B, with the times of reflux episode of 32 (21.5-43.5) vs 24 (15-37.3) , the longest duration of reflux of 6.6 (2.4-29.8) min vs 4.5 (2.5-13.2) min, the times of reflux episode longer than 5 min of 1.5 (0-3) vs 0 (0-3), and the percentage of time of pH < 4 of 4.3 (2.1-15.0)% vs 4.1 (2.0-7.2)% .

CONCLUSIONSNon-stimulating food intake before going to bed did not adversely affect the nighttime gastro-esophageal reflux.

Adolescent ; Child ; Esophageal pH Monitoring ; Feeding Behavior ; Female ; Gastroesophageal Reflux ; etiology ; Humans ; Male ; Time Factors

Esophageal pH monitoring is considered the gold standard for the diagnosis of gastroesophageal reflux disease because of the normal ranges across the pediatric age range. However, this method can only detect acid reflux. Multichannel intraluminal impedance-pH (MII-pH) monitoring has recently been used for the detection of bolus reflux in infants and children. This method allows for the detection of liquid, gas or mixed reflux in addition to acid, weakly acidic or weakly alkaline reflux. MII-pH monitoring can record the direction of flow and the height of reflux, which are useful parameters to identify an association between symptoms and reflux. However, the technique is limited by its high cost and the lack of normative data of MII-pH in the pediatric population. Despite certain limitations, MII-pH monitoring will become more common and gradually replace pH monitoring in the future, because pH monitoring is part of MII-pH.
Child* ; Diagnosis ; Esophageal pH Monitoring ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration* ; Infant ; Reference Values

PURPOSE: We investigated the incidence of gastroesophageal reflux disease (GERD) by 24-hour esophageal pH monitoring in patients who had chronic cough for more than 3 weeks. METHODS: From January 1995 to August 1996, 33 patients with chronic cough which had lasted for more than 3 weeks were enrolled in the 24-hour esophageal pH monitoring. The result was interpreted with the standard value which was suggested by Yvan Vandenplas in 1991 for patients younger than 15 months and with the De Meester Score for patients older than 15 months. We performed esophagoscopy and lower esophageal biopsy for patients who proved to have gastroesophageal reflux disease by 24-hour esophageal pH monitoring. RESULTS: Among 33 cases, 13 cases (39.4%) were proved to have GERD. Comparing between the normal group and the GERD group, there was no difference of gastroesophageal reflux incidence according to meal or position. We performed esophagoscopy in 10 patients among 13 GERD cases. There were 3 cases of gross esophagitis. Papillary height was elongated by more than 50% of normal in 7 cases, and basal cell layer increased by more than 20% of normal in 6 cases. Neutrophil or eosinophil infiltration was found in 2 cases, and lymphocyte infiltration was found in 7 cases. CONCLUSION: We suggest that 24-hour esophageal pH monitoring and appropriate treatment should be considered in prolonged unexplained chronic cough.
Biopsy ; Child* ; Cough* ; Eosinophils ; Esophageal pH Monitoring ; Esophagitis ; Esophagoscopy ; Gastroesophageal Reflux* ; Humans ; Incidence ; Lymphocytes ; Meals ; Neutrophils

BACKGROUND: The prevalence of Gastro-esophageal reflux(GER) in patients with asthma is estimated to be 50~60% and treatment of GER has been shown to improve asthma symptoms in Western. But GER has been known to be less common in Eastern and GER prevalence rates in asthmatics are not available in Korea. METHOD: We compared the prevalence rate of GER in 42 patients with asthma to that in 20 healthy normal controls and examed the efficacy of new prokinetic drug, cisapride(40mg/day, 8weeks) in patients with GER and asthma. For acid GER to be considered pathological, 24 hour esophageal pH monitoring should reveal values exceeding upper limit of 95 percentile for at least one of 6 parameter of DeMesseter's table. RESULT: The results showed GER was more common in patients with asthma(11/42, 26.2%) than normal controls(3/20, 15%) and asthmatics group showed a significant longer supine time pH<4(%) and total time pH<4(%), and more reflux episodes as compared with normal control group. After 4 asthmatics with GER were treated with cisapride, their asthma symtom scores, FEV1 and composite scores of pH monitoring were improved. CONCLUSION: GER is more common in asthmatics than in normal controls in Korea and prepulsid reduces asthma symptoms in patients with GER and asthma.
Asthma ; Cisapride ; Esophageal pH Monitoring ; Gastroesophageal Reflux* ; Humans ; Hydrogen-Ion Concentration ; Korea ; Prevalence

BACKGROUND/AIMS: Several specific foods are known to precipitate gastroesophageal reflux disease (GERD) symptoms and GERD patients are usually advised to avoid such foods. However, foods consumed daily are quite variable according to regions, cultures, etc. This study was done to elucidate the food items which induce typical GERD symptoms in Korean patients. METHODS: One hundred and twenty-six Korean patients with weekly typical GERD symptoms were asked to mark all food items that induced typical GERD symptoms from a list containing 152 typical foods consumed daily in Korea. All patients underwent upper gastrointestinal endoscopy followed by 24-hour ambulatory esophageal pH monitoring. The definition of “GERD” was if either of the 2 studies revealed evidence of GERD, and “possible GERD” if both studies were negative. RESULTS: One hundred and twenty-six cases (51 GERD and 75 possible GERD) were enrolled. In 19 (37.3%) of 51 GERD cases and in 17 (22.7%) of 75 possible GERD cases, foods inducing typical GERD symptoms were identified. In the GERD group (n = 19), frequent symptom-inducers were hot spicy stews, rice cakes, ramen noodles, fried foods, and topokki. In the possible GERD group (n = 17), frequent symptom-inducers were hot spicy stews, fried foods, doughnuts, breads, ramen noodles, coffee, pizza, topokki, rice cakes, champon noodles, and hotdogs. CONCLUSIONS: In one-third of GERD patients, foods inducing typical symptoms were identified. Hot spicy stews, rice cakes, ramen noodles, fried foods, and topokki were the foods frequently inducing typical symptoms in Korea. The list of foods frequently inducing typical GERD symptoms needs to be modified based on their own local experiences.
Bread ; Coffee ; Endoscopy, Gastrointestinal ; Esophageal pH Monitoring ; Gastroesophageal Reflux* ; Humans ; Korea* ; Symptom Assessment