Guanosine triphosphate (GTP)-dependent stimulation of rabbit gallbladder mucosal adenylate cyclase by prostaglandins

Abstract

ASSESSING THE CLINICAL SEVERITY OF REFLUX ESOPHAGITIS. R.Menin,L.Malmud,R.Peterson,K.Phaosawasdi, and R.Fisher, Temple University Hospital, Philadelphia, Pennsylvania. Data which correlate the severity of reflux symptoms with the results of diagnostic tests in patients with esophagitis are not available. The need for such data is emphasized by the recent enthusiasm for anti-reflux surgery. The purpose of this study was to rate symptom severity and correlate symptom scores with the results obtained from diagnostic tests. Thirty-six patients with esophagitis were evaluated by endoscopy, mucosal biopsy with pinch forceps, esophageal manometry and gastroesophageal scintiscanning. Heartburn, regurgitation and dysphagia were rated numerically, and the severity of esophagitis was classified clinically as mild, moderate or severe based on symptom scores. Endoscopic esophagitis correlated with symptoms. Symptom scores were 3.750.4, 3.4+0.4 (P>.OS), 5.7kO.4 (Pc.01) and 7.0+_0.5 (Pc.001) respectively, in normal and mild, moderate and severe endoscopic esophagitis. All patients with moderate or severe symptoms had endoscopic esophagitis. Symptoms did not correlate with the severity of histologic esophagitis or with resting LES pressures (r,O.Z). However, LES pressure was below 10 mmHg in 23 of 27 patients with moderate or severs symptoms. Biopsy specimens could not be interpreted in 19% of patients. Symptoms correlated significantly with gastroesophageal reflux indices (r,0.7). Reflux indices were a'bove lo/ in all patients with severe symptoms. In those selected for anti-reflux surgery, endoscopic esophagitis was present in 83%, LES pressure was less than 10 mmHg in 75% and the gastroesophageal reflux index was greater than 10% in 92%. Conclusion: In patients with esophagitis, the severity of symptoms correlates with the severity of endoscopic esophagitis and the quantity of reflux, but not with LES pressure or histologic esophagitis. Analyses of these results might assist the clinician to determine which of his patients might require surgical treatment.