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DOI: 10.1055/s-2005-869802
Delayed gastric emptying predisposes to non-acid reflux
Background: Delayed gastric emptying (DGE) was proved to play role in the development of gastroesophageal reflux disease (GERD), but the prevalence of gastric emptying disorder varies in different studies. Early GERD was identified by an abnormal postprandial response to a standardized test meal in symptomatic patients.1
The aim was to investigate the correlation between gastric emptying and postprandial (PP) reflux.
Materials and methods: 20 patients (12 males, 8 females, mean age=47 years, range 27–72) with GERD symptoms were examined. 24-hr esophageal pH metry (Medtronic-Synetics, Digitrapper Mark 4,) and 13C octanoic acid solid state gastric emptying (Infra Red Isotope Analyser, Wagner Analysen Technik, Germany) were performed simultaneously in each patients. Standardized test meal was given two hours after the begining of esophageal pH-metry. Gastric emptying coefficient (GEC) and T1/2 were calculated.2 Number of acid refluxes, percent time pH <4 at 5cm above the lower esophageal sphincter were analysed.
Results: There was no difference between the prevalence of DGE in acid reflux positive and non-acid reflux patients. 13 of 20 symptom positive GERD patients had abnormal esophageal pH-score, their average GEC and T1/2 were 3.75±0.34 110±9min respectively. 7 of 20 symptom positive patients had normal pH-score, with GEC 2.61±0.62 and T1/2 192±11min respectively (p<0.01 vs. positive pH score group).
|
|
Normal gastric emptying |
Delayed gastric emptying |
||||||
|
|
Prepr. 2 hrs |
Postpr. 2 hrs |
Postpr. First hr |
Postpr. Second hr |
Prepr. 2 hrs |
Postpr. 2 hrs |
Postpr. First hr |
Postpr. Second hr |
|
Number of acid reflux |
5.4±2.9 |
27±4.3 |
7±2 |
21±5.2 |
2±1.7 |
12±2.6 ** |
2±1.1 |
10.5±2 |
|
%time pH<4 |
2.3±1 |
28.2±6.1 |
12±2.7 |
25.4±3.2 |
0.9±0.4 |
12.8±3 ** |
11.9±2 |
18±4 |
**p<0.05 vs. normal gastric emptying postprandial 2 hrs.
Conclusions: Postprandial acid reflux is reduced by DGE by its puffering capacity. Acid reflux was found to be present dominantly in the second hour postprandialy. Thus gastric emptying measurement with standardised test meal combined with pH-metry seems to be a sensitive method to detect reflux in symptomatic GERD patients.
1T.R. DeMeester et al. Gastroenterology 2004, 126 Suppl.2 A-318.
2Ghoos et al. Gastroenterology 1993,104:1640–1647.
Grant support: F034433, ETT 550/2002.