Original Paper

Digestive Diseases and Sciences

, Volume 53, Issue 6, pp 1506-1512

First online:

Acid and Non-Acid Reflux Patterns in Patients with Erosive Esophagitis and Non-Erosive Reflux Disease (NERD): A Study Using Intraluminal Impedance Monitoring

  • José M. ConchilloAffiliated withDepartment of Gastroenterology and Hepatology, University Medical Center Email author 
  • , Matthijs P. SchwartzAffiliated withDepartment of Gastroenterology and Hepatology, University Medical Center
  • , Mohamed SelimahAffiliated withDepartment of Gastroenterology and Hepatology, University Medical Center
  • , Melvin SamsomAffiliated withDepartment of Gastroenterology and Hepatology, University Medical Center
  • , Daniel SifrimAffiliated withDepartment of Gastroenterology, University Hospital KU Leuven
  • , André J. SmoutAffiliated withDepartment of Gastroenterology and Hepatology, University Medical Center

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Abstract

Background Non-erosive reflux disease (NERD) and erosive esophagitis (EE) are the most common phenotypic presentations of gastroesophageal reflux disease (GERD). Aim To assess acid and non-acid reflux patterns in patients with EE and NERD using combined esophageal pH-impedance monitoring. Methods A total of 26 GERD patients off acid-suppressive medication and ten healthy volunteers (HV) underwent upper endoscopy and 24-h pH-impedance monitoring. Analysis of the pH-impedance signals included total reflux time, number of reflux episodes according to gas–liquid composition, and pH (acid, non-acid). Results EE was identified in 13 patients and NERD in 13 patients. Pathologic acid reflux was found in 92.3 and 69.2% of patients with EE and NERD, respectively (P = 0.15). When compared to HV, EE patients and NERD patients showed a higher incidence of acid (P = 0.002 and P < 0.001, EE vs. HV and NERD vs. HV, respectively) and non-acid reflux episodes (P = 0.03 and P = 0.001, EE vs. HV and NERD vs. HV, respectively). Mean reflux times, as assessed by both pH-metry and impedance monitoring, and incidence of acid and non-acid reflux episodes were similar in EE and NERD patients. In the supine position, however, EE patients showed a higher incidence of acid (P = 0.048) and liquid reflux episodes (P = 0.07). Conclusion Whereas EE patients have more acid reflux episodes in the supine position than NERD patients, patients with EE and NERD have similar non-acid reflux patterns. This observation lends support to the notion that non-acid reflux is less damaging to the esophageal mucosa than acid reflux.

Keywords

Acid reflux Erosive esophagitis Gastroesophageal reflux disease Impedance monitoring Non-acid reflux Non-erosive reflux disease