Origin of atypical reflux symptoms
In summary, we evaluated a 39-year-old man two years after partial esophagectomy and gastroesophageal anastomosis. He had developed recurrent Barrett's esophagus and atypical reflux symptoms. We found free reflux and no antireflux barrier at the hiatus or the esophagogastric anastomosis. Three different reflux techniques performed simultaneously demonstrated that the composition of refluxant varied with posture, explaining the atypical nature of the symptoms. In the left recumbent posture, the refluxate was comprised of acidified liquid and gaseous gastric contents with the patient complaining of heartburn and chest pain. In the right recumbent posture the refluxate was composed of only nonacidic gas, and the patient complained of chest pain without heartburn. We propose that multiple reflux tests performed simultaneously in the setting where a patient experiences his atypical symptoms may help clarify their origin. Furthermore, this case illustrates how posture may dramatically influence refluxant composition.
Key wordsgastroesophageal reflux posture atypical reflux symptoms
Unable to display preview. Download preview PDF.
- 1.Dent J: A new technique for continuous sphincter pressure measurements. Gastroenterology 71:263–267, 1976Google Scholar
- 2.Klein WA, Parkman HP, Dempsey DT, Fisher RS: Sphincter-like thoracoabdominal high pressure zone after esophagogastrectomy. Gastroenterology 105:1362–1369, 1993Google Scholar
- 3.Johnson LF, DeMeester TR: Twenty-four-hour pH monitoring of the distal esophagus: A quantitative measure of gastroesophageal reflux. Am J Gastroenterol 62:325–332, 1974Google Scholar
- 4.Shay SS, Eggli D, Johnson LF: Simultaneous esophageal pH monitoring and scintigraphy during the postprandial period in patients with severe reflux esophagitis. Dig Dis Sci 36:558–564, 1991Google Scholar
- 5.Shay SS, Eggli D, Johnson LF: Cycling, a manometric phenomena due to repetitive episodes of gastroesophageal reflux and clearance. Dig Dis Sci 34:1340–1348, 1989Google Scholar
- 6.Helm JF, Dodds WJ, Pele LR, Palmer DW, Hogan WJ, Teeter BC: Effect of esophageal emptying and saliva on clearance of acid from the esophagus. N Engl J Med 310:284–288, 1984Google Scholar
- 7.Kahrilas PJ, Dodds WJ, Hogan WJ: Dysfunction of the belch reflex. A cause of incapacitating chest pain. Gastroenterology 93:818–822, 1987Google Scholar
- 8.Conwell D, Shay SS, Mehindru V, Hertz, B: Posture influences reflux event (RE) composition and well as RE frequency during fasting. Am J Gastroenterol 91:54–60, 1996Google Scholar
- 9.Altorki NK, Skinner DB, Segalin A, Stephens JK, Ferguson MK, Little AG: Indications for esophagectomy in nonmalignant Barrett's esophagus: A 10-year experience. Ann Thorac Surg 49:724–727, 1990Google Scholar
- 10.Clouse RE, Ferney DM: Rhythmic spontaneous contractions in patients with esophageal symptoms. Am J Gastroenterol 81:666–671, 1986Google Scholar