Gastro-Oesophageal Reflux in Italian Healthy Volunteers and Patients: Relationship between Gastro-Oesophageal Reflux, Endoscopic Oesophagitis and Symptoms

Abstract

Prolonged pH monitoring of the distal oesophagus is considered the most sensitive test for detecting gastro-oesophageal reflux (GOR). Local patterns of GOR are needed because of its large diffusion in countries with different dietetic and behavioural habits and the use of the test in outpatients. 15 healthy volunteers and 30 patients affected by GOR disease were studied by means of a 24-hour oesophageal pH test. Moreover, the results obtained in the pathological group were compared with endoscopic findings and symptoms to find out whether there exists a relationship between pH test, oesophagitis and symptom severity. We found an average of 25 ± 17.3 reflux episodes/24 h; the percentage of acid exposure of the distal oesophagus was 1.6 ± 1.4; the percentage of acid exposure while the volunteers where recumbent was 0.81 ± 1.09: the number of reflux episodes longer than 5 min was 0.57 ± 1.04 and the duration of the longest episode was 4.5 ± 3 min in healthy subjects. There were no statistical differences compared with the values of healthy American subjects except for the percentage of acid exposure in supine position. This higher exposure of the distal oesophagus to the gastric refluxed juice could be explained by the different dietetic habits of the Italian volunteers, who ate late in the evening and went to bed in the postprandial phase. In the pathological group (identified by values greater than the mean plus 2 SD) no connection between the severity of oesophagitis and the severity of refluxes was observed. The pH test discriminated only symptomatic patients with or without oesophagitis but allowed no further division in this group to be made. The severity of the symptoms was related only to the percentage of acid exposure of the distal oesophagus in upright position. No relationship with the other parameters adopted was found. In conclusion, the 24-hour pH test is the test of choice for detecting and quantifying GOR disease. However, it is only a semiquantitative test and cannot be used for a prognosis of GOR disease development.