Abstract
Objective
To determine the characteristics of postprandial proximal gastric acid pockets (PPGAPs) and their association with gastroesophageal acid reflux in patients with Barrett’s esophagus (BE).
Methods
Fifteen patients with BE (defined by columnar lined esophagus of ≥1 cm) and 15 healthy individuals that were matched for age, gender, and body mass index, were recruited. The fasting intragastric pH and the appearance time, length, lowest pH, and mean pH of the PPGAP were determined using a single pH electrode pull-through experiment. For BE patients, a gastroesophageal reflux disease questionnaire (GerdQ) was completed and esophageal 24-h pH monitoring was carried out.
Results
The PPGAP was significantly longer (5 (3, 5) cm vs. 2 (1, 2) cm) and the lowest pH (1.1 (0.8, 1.5) vs. 1.6 (1.4, 1.9)) was significantly lower in patients with short-segment BE than in healthy individuals. The PPGAP started to appear proximally from the gastroesophageal pH step-up point to the esophageal lumen. The acidity of the PPGAP was higher in the distal segment than in the proximal segment. In short-segment BE patients, there were significant correlations between the acidity and the appearance time and length of the PPGAP. The length and acidity of the PPGAP were positively associated with gastroesophageal acid reflux episodes. The acidity of the PPGAP was associated with the DeMeester scores, the GerdQ scores, and the fasting intragastric pH.
Conclusions
In patients with short-segment BE, a PPGAP is commonly seen. Its length and acidity of PPGAP are associated with gastroesophageal acid reflux, the DeMeester score, and the GerdQ score in patients with short-segment BE.
概要
目 的
检测并分析短节段 Barrett’s 食管 (BE) 患者的餐后近端胃酸袋 (PPGAP) 的特点, 并分析其与胃食管酸反流的相关性.
创新点
PPGAP 可能是胃食管反流病的病理因素之一, 引起广泛关注, 而 BE 患者的 PPGAP 特点及与反流的相关性尚无报道.
方 法
15 名短节段BE 患者和15 名健康志愿者分别以 牵拉法检测PPGAP 的发生时间、长度、最低pH 值和平均pH 值.BE 患者完成GerdQ 问卷调查 和24 h 食管pH 监测.
结 论
短节段 BE 患者普遍存在 PPGAP, 同时 PPGAP 的长度和酸度与其胃食管酸反流周期数、 DeMeester 评分和 GerdQ 评分具有相关性.
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Acknowledgments
We thank the Medjaden Bioscience Limited (Wuhan, China) for scientific editing of this manuscript.
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Yuan-yuan NIAN performed the experimental research, writing and editing of the manuscript. Jing WU performed the data analysis. Xian-mei MENG and Jun ZHANG performed the study design, data analysis, and editing of the manuscript. Fu-chu JING, Xue-qin WANG, and Tong DANG contributed to the study design. All authors have read and approved the final manuscript and, therefore, have full access to all the data in the study and take responsibility for the integrity and security of the data.
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Yuan-yuan NIAN, Xian-mei MENG, Jing WU, Fu-chu JING, Xue-qin WANG, Tong DANG, and Jun ZHANG declare that they have no conflict of interest.
This study was approved by the Medical Ethics Committee of the Second Affiliated Hospital of Xi’an Jiaotong University (Xi’an, China). All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.
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Project supported by the Natural Science Foundation of Inner Mongolia Autonomous Region (Nos. 2019LH08042 and 2018MS08050) and the Natural Science Foundation of Baotou Medical College (No. BYJJ-YF-2018024), China
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Nian, Yy., Meng, Xm., Wu, J. et al. Postprandial proximal gastric acid pocket and its association with gastroesophageal acid reflux in patients with short-segment Barrett’s esophagus. J. Zhejiang Univ. Sci. B 21, 581–589 (2020). https://doi.org/10.1631/jzus.B1900498
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DOI: https://doi.org/10.1631/jzus.B1900498
Key words
- Short-segment Barrett’s esophagus
- Postprandial proximal gastric acid pocket (PPGAP)
- Gastroesophageal acid reflux