Measurement of gastrow-oesophageal acid reflux: Its significance in hiatus hernia

Abstract

Gastro-oedophageal reflux may be responsible for symptoms and sometimes for the development of oesophageal damage. These effects are inconstant when reflux is demonstrated by radiography or by conuentional pH studies. This unpredictability may be accounted for by the observation that during the day refluxed material is rapidly cleared from the oesophagus by swallowing, while during sleep little swallowing occurs. To explore the hypothesis that reflux during deep is the important factor, prolongedintra-oesophageal pH studies have been done and a method has been developed for quantifying nocturnal gastro-oesophageal reflux. The investigation has Ahown that persistence of acid within the oesophagus is associated with prolonged periods during sleep when no swallowing occurs. Measurements of nocturnal intra-oesophageal pH were made in 41 patients with symptomatic sliding hiatus hernia. In 12 patients with mild symptoms reflux measured by this index did not exceed 15 minutes, with one exception, and no patient showed oesophagitis. In 10 patients with moderate symptoms reflux did not exceed 1 hour, with one exception, and mild to moderate oesophagitis was present in 4 cases. Nineteen patients had severe symptoms; in all hut one the period of reflux was in excess of 1 hour, and oesophagitis was found in 13.