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Factors that Impact Day-to-Day Esophageal Acid Reflux Variability and Its Diagnostic Significance for Gastroesophageal Reflux Disease

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Abstract

Gastroesophageal reflux disease (GERD) is a common disease affecting a significant number of adults both globally and in the USA. GERD is clinically diagnosed based on patient-reported symptoms, and the gold standard for diagnosis is ambulatory reflux monitoring, a tool particularly utilized in the common scenario of non-response to therapy or atypical features. Over the past 20 years, there has been a shift toward extending the duration of reflux monitoring, initially from 24 to 48 h and more recently to 96 h, primarily based on a demonstrated increase in diagnostic yield. Further, multiple studies demonstrate clinically relevant variability in day-to-day acid exposure levels in nearly 30% of ambulatory reflux monitoring studies. For these reasons, an ongoing clinical dilemma relates to the optimal activities patients should engage in during prolonged reflux monitoring. Thus, the aims of this review are to detail what is known about variability in daily acid exposure, discuss factors that are known to influence this day-to-day variability (i.e., sleep patterns, dietary/eating habits, stress, exercise, and medications), and finally provide suggestions for patient education and general GERD management to reduce variation in esophageal acid exposure levels.

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Abbreviations

AET:

Acid exposure time

ACG:

American College of Gastroenterology

AGA:

American Gastroenterology Association

BGA:

Brain-gut axis

CCB:

Calcium channel blocker

GERD:

Gastroesophageal reflux disease

LES:

Lower esophageal sphincter

MNBI:

Mean nocturnal baseline impedance

PSPW:

Post-reflux swallow-induced peristaltic wave

PPI:

Proton pump inhibitor

TLESR:

Transient lower esophageal sphincter relaxation

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Authors and Affiliations

  1. Department of Medicine, University of California San Diego, La Jolla, CA, USA

    Steven D. Ma & Vandan Patel

  2. Division of Gastroenterology, Esophageal Diseases & Motility, Department of Medicine, UCSD Center for Esophageal Diseases, University of California San Diego, 9500 Gilman Drive MC 0956, La Jolla, CA, 92093, USA

    Rena Yadlapati

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  1. Steven D. Ma
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Correspondence to Rena Yadlapati.

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Stevan D. Ma: None; Vandan Patel: None; Rena Yadlapati: Consultant for Medtronic, Phathom Pharmaceuticals, StatLinkMD; Research Support: Ironwood Pharmaceuticals; Advisory Board with Stock Options: RJS Mediagnostix.

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Ma, S.D., Patel, V. & Yadlapati, R. Factors that Impact Day-to-Day Esophageal Acid Reflux Variability and Its Diagnostic Significance for Gastroesophageal Reflux Disease. Dig Dis Sci 67, 2730–2738 (2022). https://doi.org/10.1007/s10620-022-07496-7

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