Skip to main content

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

Digestive Diseases and Sciences volume 53, pages 1506–1512 (2008)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Fass S (2007) Erosive esophagitis and nonerosive reflux disease (NERD): comparison of epidemiologic, physiologic, and therapeutic characteristics. J Clin Gastroenterol 41:131–137

    PubMed  Article  Google Scholar 

  2. Dent J, Brun J, Fendrick AM, Fennerty MB, Janssens J, Kahrilas PJ et al (1999) An evidence-based appraisal of reflux disease management. The Genval workshop report. Gut 44:S1–S16

    Article  Google Scholar 

  3. Fass R, Fennerty MB, Vakil N (2001) Nonerosive reflux disease: current concepts and dilemmas. Am J Gastroenterol 96:303–314

    PubMed  CAS  Google Scholar 

  4. Fass R (2003) Epidemiology and pathophysiology of symptomatic gastroesophageal reflux disease. Am J Gastroenterol 98:S2–S7

    PubMed  Article  Google Scholar 

  5. Quigley EM (1997) Gastroesophageal reflux disease: spectrum or continuum? QJM 90:75–78

    PubMed  CAS  Google Scholar 

  6. Adachi K, Hashimoto T, Hamamoto N, Hirakawa K, Niigaki M, Miyake T et al (2003) Symptom relief in patients with reflux esophagitis: comparative study of omeprazole, lansoprazole and rabeprazole. J Gastroenterol Hepatol 18:1392–1398

    PubMed  Article  CAS  Google Scholar 

  7. Martinez SD, Malagon IB, Garewal HS, Cui H, Fass R (2003) Non-erosive reflux disease (NERD): acid reflux and symptom patterns. Aliment Pharmacol Ther 17:537–545

    PubMed  Article  CAS  Google Scholar 

  8. Dickman R, Bautista JM, Wong WM, Bhatt R, Beeler JN, Malagon I et al (2006) Comparison of esophageal acid exposure distribution along the esophagus among the different gastroesophageal reflux disease (GERD) groups. Am J Gastroenterol 101:2463–2469

    PubMed  Google Scholar 

  9. Silny J (1991) Intraluminal multiple impedance procedure for measurement of gastrointestinal motility. J Gastrointest Mot 3:151–162

    Google Scholar 

  10. Bredenoord AJ, Weusten BL, Sifrim D, Timmer R, Smout AJ (2005) Reproductivity of multichannel intraluminal electrical impedance monitoring of gastroesophageal reflux. Am J Gastroenterol 100:265–269

    PubMed  Article  Google Scholar 

  11. Sifrim D, Castell D, Dent J, Kahrilas PJ (2004) Gastroesophageal reflux monitoring: review and consensus report on detention and definitions of acid, non-acid and gas reflux. Gut 53:1024–1031

    PubMed  Article  CAS  Google Scholar 

  12. Hila A, Agrawal A, Castell DO (2007) Combined multichannel intraluminal impedance testing compared to pH alone for diagnosing both acid and weakly acidic gastroesophageal reflux. Clin Gastroenterol Hepatol 5:172–177

    PubMed  Article  CAS  Google Scholar 

  13. Weusten BL, Roelofs JM, Akkermans LM, Van Berge-Henegouwen GP, Smout AJ (1994) The symptom-association probability: an improved method for symptom analysis of 24-hour esophageal pH data. Gastroenterology 107:1741–1745

    PubMed  CAS  Google Scholar 

  14. Sifrim D, Silny J, Holloway RH, Janssens JJ (1999) Patterns of gas and liquid reflux during transient lower esophageal sphincter relaxation: a study using intraluminal electrical impedance. Gut 44:47–54

    PubMed  CAS  Article  Google Scholar 

  15. Frazzoni M, De Micheli E, Savarino V (2003) Different patterns of esophageal acid exposure distinguish complicated reflux disease from either erosive reflux esophagitis or non-erosive reflux disease. Aliment Pharmacol Ther 18:1091–1098

    PubMed  Article  CAS  Google Scholar 

  16. DeVault KR (2006) Review article: the role of acid suppression in patients with non-erosive reflux disease or functional heartburn. Aliment Pharmacol Ther 23 Suppl 1:33–9

    PubMed  Article  Google Scholar 

  17. Sifrim D, Holloway R, Silny J, Xin Z, Tack J, Lerut A et al (2001) Acid, non-acid and gas reflux in patients with gastroesophageal reflux disease during ambulatory 24-hour pH-impedance recordings. Gastroenterology 120:1588–1598

    PubMed  Article  CAS  Google Scholar 

  18. Vela MF, Camacho-Lobato L, Srinivasan R, Tutuian R, Katz PO, Castell DO (2001) Simultaneous intraesophageal impedance and pH measurement of acid and non-acid gastroesophageal reflux: effect of omeprazole. Gastroenterology 120:1599–1606

    PubMed  Article  CAS  Google Scholar 

  19. Mainie I, Tutuian R, Shay S, Vela M, Zhang X, Sifrim D et al (2006) Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicentre study using combined ambulatory impedance-pH monitoring. Gut 55:1398–1402

    PubMed  Article  CAS  Google Scholar 

  20. Frazzoni M, De Micheli E, Zentilin P, Savarino V (2004) Pathophysiological characteristics of patients with non-erosive reflux disease differ from those of patients with functional heartburn. Aliment Pharmacol Ther 20:81–88

    PubMed  Article  CAS  Google Scholar 

  21. Cicala M, Emerenziani S, Caviglia R, Guarino MP, Vavassori P, Ribolsi M et al (2003) Intra-esophageal distribution and perception of acid reflux in patients with non-erosive gastroesophageal reflux disease. Aliment Pharmacol Ther 18:605–613

    PubMed  Article  CAS  Google Scholar 

  22. Niemantsverdriet EC, Timmer R, Breumelhof R (1997) Segmental acid sensitivity of the esophagus in patients with endoscopy-negative GERD. Gastroenterology 112:A237, (Abstract)

    Google Scholar 

  23. Fass R, Naliboff B, Higa L, Johnson C, Kodner A, Munakata J et al (1998) Differential effect of long-term esophageal acid exposure on mechanosensitivity and chemosensitivity in humans. Gastroenterology 115:1363–1373

    PubMed  Article  Google Scholar 

  24. Sarkar S, Aziz Q, Woolf CJ, Hobson AR, Thompson DG (2000) Contribution of central sensitisation to the development of non-cardiac chest-pain. Lancet 356:1154–1159

    PubMed  Article  CAS  Google Scholar 

  25. Bredenoord AJ, Weusten BL, Timmer R, Smout AJ (2006) Characteristics of gastroesophageal reflux in symptomatic patients with and without excessive esophageal acid exposure. Am J Gastroenterol 101:2470–2475

    PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Gastroenterology and Hepatology, University Medical Center, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands

    José M. Conchillo, Matthijs P. Schwartz, Mohamed Selimah, Melvin Samsom & André J. Smout

  2. Department of Gastroenterology, University Hospital KU Leuven, Leuven, Belgium

    Daniel Sifrim

Authors
  1. José M. Conchillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthijs P. Schwartz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohamed Selimah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Melvin Samsom
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel Sifrim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. André J. Smout
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to José M. Conchillo.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Conchillo, J.M., Schwartz, M.P., Selimah, M. et al. Acid and Non-Acid Reflux Patterns in Patients with Erosive Esophagitis and Non-Erosive Reflux Disease (NERD): A Study Using Intraluminal Impedance Monitoring. Dig Dis Sci 53, 1506–1512 (2008). https://doi.org/10.1007/s10620-007-0059-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-007-0059-z

Keywords

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