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The postprandial acid pocket does not extend into most distal esophagus: evidence from pH studies performed immediately above the squamocolumnar junction.

Hall, Mats LU ; Wenner, Jörgen LU and Öberg, Stefan LU (2014) In Scandinavian Journal of Gastroenterology 49(1). p.15-22
Abstract
Abstract Objective. The postprandial acid pocket is suggested to be an important factor in the pathogenesis of gastroesophageal reflux disease (GERD) as it according to the theory extends into the distal esophagus. The aim of this study was to test the hypothesis that the acid pocket transverses the squamocolumnar junction (SCJ) and exposes the most distal esophagus to gastric acid for extended periods following a meal. Material and methods. Fifty asymptomatic volunteers and 75 patients with GERD underwent 48-h pH monitoring with the electrode of a pH capsule placed immediately above the SCJ. The characteristics of esophageal acid exposure from the 90-min postprandial periods were compared with those observed during the upright,... (More)
Abstract Objective. The postprandial acid pocket is suggested to be an important factor in the pathogenesis of gastroesophageal reflux disease (GERD) as it according to the theory extends into the distal esophagus. The aim of this study was to test the hypothesis that the acid pocket transverses the squamocolumnar junction (SCJ) and exposes the most distal esophagus to gastric acid for extended periods following a meal. Material and methods. Fifty asymptomatic volunteers and 75 patients with GERD underwent 48-h pH monitoring with the electrode of a pH capsule placed immediately above the SCJ. The characteristics of esophageal acid exposure from the 90-min postprandial periods were compared with those observed during the upright, preprandial periods. Results. In asymptomatic controls, the degree of postprandial esophageal acid exposure was similar to that observed in the preprandial periods (median % time with pH <4, 2.2 vs. 2.6, p = 0.165). In contrast, symptomatic patients had significantly greater acid exposure in the postprandial compared with the preprandial periods (median % time with pH <4, 15.5 vs. 8.5, p < 0.001). The higher degree of acid exposure during the postprandial periods was due to a significantly higher number of short reflux episodes and reflux events with long durations were infrequent. Conclusion. Postprandial acid exposure in the most distal esophagus was characterized by numerous short reflux events, and reflux events of long durations were rare. Our observations suggest that the acid pocket is confined to the stomach, questioning the importance of the acid pocket in GERD. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Scandinavian Journal of Gastroenterology
volume
49
issue
1
pages
15 - 22
publisher
Taylor & Francis
external identifiers
  • wos:000328948600002
  • pmid:24256116
  • scopus:84890940212
ISSN
1502-7708
DOI
10.3109/00365521.2013.845797
language
English
LU publication?
yes
id
9dd5ea7a-e5f1-4a09-8319-2cc04adfdf38 (old id 4179104)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/24256116?dopt=Abstract
date added to LUP
2013-12-02 20:45:23
date last changed
2017-01-15 03:09:06
@article{9dd5ea7a-e5f1-4a09-8319-2cc04adfdf38,
  abstract     = {Abstract Objective. The postprandial acid pocket is suggested to be an important factor in the pathogenesis of gastroesophageal reflux disease (GERD) as it according to the theory extends into the distal esophagus. The aim of this study was to test the hypothesis that the acid pocket transverses the squamocolumnar junction (SCJ) and exposes the most distal esophagus to gastric acid for extended periods following a meal. Material and methods. Fifty asymptomatic volunteers and 75 patients with GERD underwent 48-h pH monitoring with the electrode of a pH capsule placed immediately above the SCJ. The characteristics of esophageal acid exposure from the 90-min postprandial periods were compared with those observed during the upright, preprandial periods. Results. In asymptomatic controls, the degree of postprandial esophageal acid exposure was similar to that observed in the preprandial periods (median % time with pH &lt;4, 2.2 vs. 2.6, p = 0.165). In contrast, symptomatic patients had significantly greater acid exposure in the postprandial compared with the preprandial periods (median % time with pH &lt;4, 15.5 vs. 8.5, p &lt; 0.001). The higher degree of acid exposure during the postprandial periods was due to a significantly higher number of short reflux episodes and reflux events with long durations were infrequent. Conclusion. Postprandial acid exposure in the most distal esophagus was characterized by numerous short reflux events, and reflux events of long durations were rare. Our observations suggest that the acid pocket is confined to the stomach, questioning the importance of the acid pocket in GERD.},
  author       = {Hall, Mats and Wenner, Jörgen and Öberg, Stefan},
  issn         = {1502-7708},
  language     = {eng},
  number       = {1},
  pages        = {15--22},
  publisher    = {Taylor & Francis},
  series       = {Scandinavian Journal of Gastroenterology},
  title        = {The postprandial acid pocket does not extend into most distal esophagus: evidence from pH studies performed immediately above the squamocolumnar junction.},
  url          = {http://dx.doi.org/10.3109/00365521.2013.845797},
  volume       = {49},
  year         = {2014},
}