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

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

PURPOSE: The aim of this study was to show the clinical importance of each parameter of esophageal pH-metry regarding age distribution. Also, the study was done to compare the reliability of each parameter in diagnosing gastroesophageal reflux disease (GERD). METHODS: A retrospective study, based on hospital discharge registry, was conducted among 30 children who were given 24hr esophageal pH monitoring. The patients with GERD were divided into two groups i.e., group I, children under 12 months of age (24 patients), group II, children between 1-7 years of age (17 patients). We compared the clinical presentations between these two groups and analyzed each four parameters of 24hr pH monitoring. RESULTS: The study suggests that the parameter of 24hr pH monitoring with the highest effect on total score was reflux index common to both groups. In addition, comparing esophageal pH parameter, the number of the longest reflux episode according to body position, the upright positions were more associated with high total score in patients with GERD over 12 month of age. CONCLUSION: In interpretations of 24hr pH monitoring, taking each parameter and age into consideration is important. There is an inevitable overlap of data between normal and abnormal populations. Therefore, a further study with larger sample is required to establish the range of the physiologic and the pathologic GERD.
Age Distribution ; Child ; Esophageal pH Monitoring* ; Gastroesophageal Reflux* ; Humans ; Hydrogen-Ion Concentration ; Retrospective Studies

The exact incidence of esophagitis in gastroesophageal reflux disease (GERD) remains poorly understood in Korea. To determine incidence of esophagitis in GERD, from August 1988 to July 1993, endoscopy, esophageal manometry with Bernstein test, and ambulatory 24 hour esophageal pH monitoring were carried out in a group of 349 patients with symptoms of heartburn or noncardiac chest pain. Based on these studies, 151(40%) patients had some degree of GERD and pstients were categorized as having: pathologic reflux, 98 patients; symptomatic reflux, 42 patients; and sensitive mucosal reflux, 11 patients. Among 151 patients with GERD, 27 patients(18%) had some degree of esophagitis. In conclusion, 40% of patients with symptoms suggestive of GERD have GERD. GERD is divided into subgroups; pathologic reflux, symptomatic reflux, and mucosal sensitive reflux. Less than 20% of GERD have esophagitis or esophageal mucosal injury and these low incidence of mucosal injury in Korean may be due to increased esophageal mucosal resistance.
Chest Pain ; Endoscopy ; Esophageal pH Monitoring ; Esophagitis* ; Esophagitis, Peptic ; Gastroesophageal Reflux* ; Heartburn ; Humans ; Incidence* ; Korea ; Manometry

BACKGROUND: Gastroesophageal reflux disease (GERD) is a common cause of chronic cough. Nevertheless the incidence of GERD is low in Korea. We evaluated the necessity of tests for GERD as a cause of chronic cough and treatment responses to proton pump inhibitors. METHODS: Patients with cough for more than three weeks were enrolled. Patients who were diagnosed as bronchial asthma, eosinophilic bronchitis, and posterior nasal drip were differentiated. Twenty four hour ambulatory esophageal pH monitoring was performed in patients with chronic cough of unknown causes or gastroesophageal reflux symptoms. Patients were diagnosed as GERD when DeMeester composite score was over 14.7 or symptom sensitivity index was over 10 percent. We prescribed proton pump inhibitors for patients diagnosed as GERD. RESULTS: Sixty seven of 531 patients supposedly needed 24-hour ambulatory esophageal pH monitoring. 24-hour ambulatory esophageal pH monitoring was performed in 34 patients and eight patients were diagnosed as GERD. Symptoms improved in 5 patients on taking omeprazole 20~40 mg/day single or combined with prokinetic agents. CONCLUSIONS: Among patients with chronic cough, not many cases needed to take 24-hour ambulatory esophageal pH monitoring. The incidence of GERD, diagnosed by 24-hour ambulatory esophageal pH monitoring, in chronic cough of unknown causes was low. The effect of omeprazole was similar to the previous reports.
Asthma ; Bronchitis ; Cough* ; Eosinophils ; Esophageal pH Monitoring ; Gastroesophageal Reflux* ; Humans ; Incidence* ; Korea ; Omeprazole ; Proton Pump Inhibitors

Gastroesophageal reflux disease (GERD) is a disease predominantly seen in the West but there is a rising trend in Asia. Ambulatory 24-hour catheter-based pH monitoring has been the de facto gold standard test for GERD that correlates symptoms with acid reflux episodes. However, drawbacks such as patients' discomfort, and catheter displacement render the test as cumbersome and error-prone. The Bravo pH wireless system is designed to be user-friendly and has an added advantage of prolonged pH monitoring. The system is comparable to the catheter-based pH monitoring system in terms of diagnostic yield and symptom-reflux association. Indications include evaluation of patients with refractory GERD symptoms and prior to anti-reflux surgery. Bravo utilizes a wireless pH-sensing capsule with a complete prepackaged system, and a data processing software. The capsule may be positioned indirectly using endoscopic or manometric landmarks or under direct endoscopic guidance. Optimal threshold cut-off values are yet to be standardized but based on available studies, for the Asian population, it may be recommended for total % time pH < 4 of 5.8 over 48 hours. Cost is a limitation but capsule placement is relatively safe although technical failures may be seen in small percentage of cases.
Asia ; Asian Continental Ancestry Group ; Catheters ; Esophageal pH Monitoring ; Gastroesophageal Reflux* ; Humans ; Hydrogen-Ion Concentration*