3505 GASTROESOPHAGEAL PATHOPHYSIOLOGICAL FACTORS AFFECTING ENDOSCOPIC FINDINGS IN GASTROESOPHAGEAL REFLUX DISEASE (GERD).

Abstract

Purpose: To investigate (1) the relationships between endoscopic severity of GERD and gastroesophageal pathophysiology, and (2) characteristics of GERD observed after <i>H. pylori</i> eradication. Methods: 1) Fifty two GERD patients (mean age 55.7 yo, 35 males) gave informed consent to entry this study. GERD related symptoms intake (by QUEST), upper gastrointestinal endoscopy, 24 h-long gastroesophageal pH monitoring, and gastric emptying test were done within a week. pH monitoring was performed under hospitalization 72 h after stopping the drugs affecting gastric acidity. Fasting serum gastrin, pepsinogen (PG) I and II levels were measured by radioimmunoassay. Grades of endoscopic esophagitis were classified according to the Los Angeles classification into none (Grade O; 12 cases), mild (Grade A & B; 20 cases), and severe (Grade C & D; 20 cases). 2) Esophagitis happened after <i>H. pylori</i> eradication was examined in 23 patients (mean age 56.0 yo, 17 males) who succeeded in <i>H. pylori</i> eradication among 29 <i>H. pylori</i>-positive gastric ulcer patients. Results; 1) In accordance with grades, prevalence of hiatal hernia was higher (none; 3, mild; 8, severe; 15 cases), and endoscopic atrophy was milder significantly. pH monitoring findings showed higher esophageal pH<4 holding time (GER ratio: none; 6.6%, mild; 8.6%, severe; 17.5%: P<0.05) and lower gastric pH>3 holding time ratio (none; 28.2%, mild; 23.3%, severe; 16.0%: P<0.05) in patients with higher grades of esophagitis. Higher PG I level and PG I/II ratio (none; 3.2, mild; 4.0, severe; 6.0: P<0.05) were observed in severe esophagitis. No correlation with esophagitis grades were determined in the following factors; gender, age, QUEST score, <i>H. pylori</i>, nocturnal intragastric pH inversion, gastric emptying, and serum gastrin level. 2) After <i>H. pylori</i> eradication, the mean gastric pH and gastric pH>3 holding time ratio significantly decreased. GER ratio, BAO and BAO/MAO dramatically increased after eradication. Endoscopic esophagitis (Grade A) occurred in 5 patients 4 to 8 weeks after finishing the treatment. Only one patient showed GER ratio at more than 4%, and no differences in investigated factors were observed between in esophagitis and in non-esophagitis patients. Conclusions: These findings suggested that GER, gastric acid secretion capacity, and hiatal hernia of esophagus are responsible for the severity of endoscopic finding in the GERD and that other factors outside of GER may be involved in GERD after <i>H. pylori</i> eradication.